Provider Demographics
NPI:1730882093
Name:WILLIAMSON-THOMPSON, SUNNIE
Entity type:Individual
Prefix:
First Name:SUNNIE
Middle Name:
Last Name:WILLIAMSON-THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 BIG OAK RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-9173
Mailing Address - Country:US
Mailing Address - Phone:530-919-0424
Mailing Address - Fax:
Practice Address - Street 1:1220 BROADWAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5806
Practice Address - Country:US
Practice Address - Phone:530-626-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1683183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician