Provider Demographics
NPI:1669189833
Name:THOMPSON, GAGE ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:GAGE
Middle Name:ROBERT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 N 155TH CT APT 10202
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4638
Mailing Address - Country:US
Mailing Address - Phone:402-681-5481
Mailing Address - Fax:
Practice Address - Street 1:1525 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2434
Practice Address - Country:US
Practice Address - Phone:402-721-8872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist