Provider Demographics
NPI:1285970475
Name:TOM'S EXPRESS DRUGS, LLC
Entity type:Organization
Organization Name:TOM'S EXPRESS DRUGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, JD
Authorized Official - Phone:407-354-5365
Mailing Address - Street 1:403 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-2932
Mailing Address - Country:US
Mailing Address - Phone:318-728-3353
Mailing Address - Fax:318-728-0703
Practice Address - Street 1:403 SPENCER ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2932
Practice Address - Country:US
Practice Address - Phone:318-728-3353
Practice Address - Fax:318-728-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy