Healthcare Provider Details

I. General information

NPI: 1891728226
Provider Name (Legal Business Name): KOMOTO PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 TRUXTUN AVE #100
BAKERSFIELD CA
93301-3703
US

IV. Provider business mailing address

2110 TRUXTUN AVE #100
BAKERSFIELD CA
93301-3703
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-7524
  • Fax: 661-327-8793
Mailing address:
  • Phone: 661-327-7524
  • Fax: 661-327-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43860
License Number StateCA

VIII. Authorized Official

Name: MICHAEL URMSTON
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 661-327-7524