Provider Demographics
NPI:1558468868
Name:THOMPSON DRUG EAST BERNSTADT
Entity Type:Organization
Organization Name:THOMPSON DRUG EAST BERNSTADT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:BRITT
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-843-2211
Mailing Address - Street 1:1088 HWY 490
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729
Mailing Address - Country:US
Mailing Address - Phone:606-843-2211
Mailing Address - Fax:606-843-9434
Practice Address - Street 1:1088 HWY 490
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729
Practice Address - Country:US
Practice Address - Phone:606-843-2211
Practice Address - Fax:606-843-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYE06645332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54003348Medicaid
KY9001311100OtherMEDICAID DME PROVIDER NUMBER
KY9001311100OtherMEDICAID DME PROVIDER NUMBER