Provider Demographics
NPI:1295760817
Name:THOMPSON DRUG SADDLEBROOK, INC.
Entity type:Organization
Organization Name:THOMPSON DRUG SADDLEBROOK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P./MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:606-862-6261
Mailing Address - Street 1:575 W LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8208
Mailing Address - Country:US
Mailing Address - Phone:606-862-6261
Mailing Address - Fax:606-862-2187
Practice Address - Street 1:575 W LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8208
Practice Address - Country:US
Practice Address - Phone:606-862-6261
Practice Address - Fax:606-862-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06759332BC3200X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54003322Medicaid
1827332OtherNCPDP
KY90005588Medicaid