Provider Demographics
NPI:1396293775
Name:THOMPSON DRUG BURNING SPRINGS, INC
Entity type:Organization
Organization Name:THOMPSON DRUG BURNING SPRINGS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-599-8891
Mailing Address - Street 1:810 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1428
Mailing Address - Country:US
Mailing Address - Phone:606-878-7713
Mailing Address - Fax:606-878-9458
Practice Address - Street 1:11901 N HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-4859
Practice Address - Country:US
Practice Address - Phone:606-599-8891
Practice Address - Fax:606-598-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP078033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164233OtherPK
KY7100427480Medicaid