Provider Demographics
NPI:1023120508
Name:THOMPSON DRUG SOUTH, INC.
Entity type:Organization
Organization Name:THOMPSON DRUG SOUTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-864-6324
Mailing Address - Street 1:975 S LAUREL RD STE A
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-7862
Mailing Address - Country:US
Mailing Address - Phone:606-864-6324
Mailing Address - Fax:606-877-3197
Practice Address - Street 1:975 S LAUREL RD STE A
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-7862
Practice Address - Country:US
Practice Address - Phone:606-864-6324
Practice Address - Fax:606-877-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008633183500000X
KY4505240001332B00000X
KYP063923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54033766Medicaid
KY90200668Medicaid
KY90200668Medicaid