MR. Shane Eden Thompson

NPI #1841558111 in Fort Bragg, California

Provider Information

NPI Number: 1841558111
Entity Type: Individual
Name: MR. Shane Eden Thompson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Apr 24, 2012
Last Updated: Apr 24, 2012

Practice Location

Address: 490 S MAIN ST
City: Fort Bragg
State: California
ZIP Code: 95437-4806
Phone: (707) 964-1214

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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