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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