MEDICARE: TOMPKINSVILLE DRUGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1871133116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMPKINSVILLE DRUGS LLC

Provider Business Mailing Address
First Line	:	1513 EDMONTON RD
Second Line	:
City	:	TOMPKINSVILLE
State	:	KY
Zip	:	42167-9402
Country	:	US
Telephone Number	:	270-487-6155
Fax Number	:	270-487-6157

Provider Business Practice Location Address
First Line	:	1513 EDMONTON RD
Second Line	:
City	:	TOMPKINSVILLE
State	:	KY
Zip	:	42167-9402
Country	:	US
Telephone Number	:	270-487-6155
Fax Number	:	270-487-6157

Authorized Official
Title or Position	:	OWNER/PIC
Name	:	JOHN P NIXON
Credential	:
Telephone Number	:	270-487-6155

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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