Provider Demographics
NPI:1821181355
Name:TOMLYN, INC
Entity Type:Organization
Organization Name:TOMLYN, INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHMITTGENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-638-3535
Mailing Address - Street 1:7922 MACKENZIE ROAD
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-2721
Mailing Address - Country:US
Mailing Address - Phone:314-638-3535
Mailing Address - Fax:314-638-0351
Practice Address - Street 1:7922 MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-2721
Practice Address - Country:US
Practice Address - Phone:314-638-3535
Practice Address - Fax:314-638-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2613859OtherNABP
MO620307702Medicaid
MO600307706Medicaid
MO600307706Medicaid
MOBM5765310OtherDEA
MO4420350001Medicare NSC