Provider Demographics
NPI:1982647285
Name:HERBST APOTHECARY INC
Entity Type:Organization
Organization Name:HERBST APOTHECARY INC
Other - Org Name:HERBST COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:765-452-9000
Mailing Address - Street 1:207 N DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4131
Mailing Address - Country:US
Mailing Address - Phone:765-452-9000
Mailing Address - Fax:765-452-9633
Practice Address - Street 1:207 N DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4131
Practice Address - Country:US
Practice Address - Phone:765-452-9000
Practice Address - Fax:765-452-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
IN60005905A3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1560386OtherNCPDP PROVIDER IDENTIFICATION NUMBER