Healthcare Provider Details

I. General information

NPI: 1174299267
Provider Name (Legal Business Name): JARED TOMPKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MARKET PLACE CIR
GEORGETOWN KY
40324-7400
US

IV. Provider business mailing address

106 MARKET PLACE CIR
GEORGETOWN KY
40324-7400
US

V. Phone/Fax

Practice location:
  • Phone: 859-317-6080
  • Fax: 859-317-6079
Mailing address:
  • Phone: 859-317-6080
  • Fax: 859-317-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03441515
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number022239
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022239
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: