Provider Demographics
NPI:1548265440
Name:THOMPSON, MAYA A (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-0850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:928-674-7463
Practice Address - Street 1:CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Practice Address - Street 2:PO DRAWER PH OFF HIGHWAY 191
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ129841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy