Provider Demographics
NPI:1295441178
Name:TOMPKINS, KEVIN JOSEPH
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7031
Mailing Address - Country:US
Mailing Address - Phone:318-381-3900
Mailing Address - Fax:
Practice Address - Street 1:2701 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6128
Practice Address - Country:US
Practice Address - Phone:318-361-9762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist