Healthcare Provider Details

I. General information

NPI: 1851195853
Provider Name (Legal Business Name): TABULA RASA HEALTHCARE GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 CALIFORNIA AVE # 101
CORONA CA
92881-7253
US

IV. Provider business mailing address

1181 CALIFORNIA AVE # 101
CORONA CA
92881-7253
US

V. Phone/Fax

Practice location:
  • Phone: 888-974-2763
  • Fax:
Mailing address:
  • Phone: 888-974-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD MICHAEL DONNELLY
Title or Position: SENIOR VICE PRESIDENT
Credential: RPH
Phone: 216-369-2200