Healthcare Provider Details

I. General information

NPI: 1235569203
Provider Name (Legal Business Name): TOOLE'S COMPOUNDING PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CITATION LN
CAMPBELLSBURG KY
40011-7590
US

IV. Provider business mailing address

5815 S MAIN ST
EMINENCE KY
40019-1128
US

V. Phone/Fax

Practice location:
  • Phone: 502-550-1438
  • Fax:
Mailing address:
  • Phone: 502-550-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07580
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberP07580
License Number StateKY

VIII. Authorized Official

Name: MR. HAROLD TODD TOOLE
Title or Position: PRESIDENT/PHARMACIST-IN-CHARGE
Credential: RPH, CCN
Phone: 502-550-1438