Healthcare Provider Details

I. General information

NPI: 1952419046
Provider Name (Legal Business Name): TOMPKINSVILLE DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/20/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 EDMONTON RD
TOMPKINSVILLE KY
42167-9402
US

IV. Provider business mailing address

1513 EDMONTON RD
TOMPKINSVILLE KY
42167-9402
US

V. Phone/Fax

Practice location:
  • Phone: 270-487-6155
  • Fax: 270-487-6157
Mailing address:
  • Phone: 270-487-6155
  • Fax: 270-487-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP00880
License Number StateKY
# 7
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN P NIXON
Title or Position: OWNER
Credential:
Phone: 270-487-6155