Organization
TOMBERT INC
Active
Organization
TOMBERT INC
Active
Other names
TOMS FAMILY PHARMACY, Tom's Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KATHRINE DETRAZ (CEO)
(270) 885-1524
Entity
Organization
Contact information
Practice address
815 COUNTRY CLUB LN, HOPKINSVILLE, KY 42240-1346
(270) 885-1524
(270) 885-5022
Mailing address
815 COUNTRY CLUB LN, HOPKINSVILLE, KY 42240-1346
(270) 885-1524
(270) 885-5022
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P01274
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2029476
PK
—
05
—
54015813
—
KY
Enumeration date
07/30/2006
Last updated
05/07/2024
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