Healthcare Provider Details

I. General information

NPI: 1750373064
Provider Name (Legal Business Name): HERBST APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/09/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N DIXON RD
KOKOMO IN
46901-4131
US

IV. Provider business mailing address

201 N DIXON RD
KOKOMO IN
46901-4131
US

V. Phone/Fax

Practice location:
  • Phone: 765-457-1191
  • Fax: 765-868-3184
Mailing address:
  • Phone: 765-457-1191
  • Fax: 765-868-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60002425A
License Number StateIN

VIII. Authorized Official

Name: HEIDI TANNER
Title or Position: PRESIDENT
Credential: RPH
Phone: 765-457-1191