Organization
HERBST APOTHECARY INC
Active
Other names
HERBST COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI TANNER RPH (PRESIDENT)
(765) 452-9000
Entity
Organization
Contact information
Practice address
207 N DIXON RD, KOKOMO, IN 46901-4131
(765) 452-9000
(765) 452-9633
Mailing address
207 N DIXON RD, KOKOMO, IN 46901-4131
(765) 452-9000
(765) 452-9633
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
60005905A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1560386
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/14/2006
Last updated
03/09/2024
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