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	3336C0004X	Compounding Pharmacy
2	3336M0003X	Managed Care Organization Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	333600000X	Pharmacy
5	3336C0002X	Clinic Pharmacy
6	3336C0003X	Community/Retail Pharmacy	P00880	KY
7	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2029139	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952419046
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
Name	:	JOHN P NIXON
Credential	:
Telephone Number	:	270-487-6155

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/20/2021

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