Provider Demographics
NPI:1952419046
Name:TOMPKINSVILLE DRUGS LLC
Entity Type:Organization
Organization Name:TOMPKINSVILLE DRUGS LLC
Other - Org Name:TOMPKINSVILLE DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-487-6155
Mailing Address - Street 1:1513 EDMONTON RD
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-9402
Mailing Address - Country:US
Mailing Address - Phone:270-487-6155
Mailing Address - Fax:270-487-6157
Practice Address - Street 1:1513 EDMONTON RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-9402
Practice Address - Country:US
Practice Address - Phone:270-487-6155
Practice Address - Fax:270-487-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X, 3336C0003X, 3336C0004X, 3336M0003X
KYP008803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029139OtherPK
KY90050865Medicaid
KY54006275Medicaid
KY9005086500Medicaid