Healthcare Provider Details

I. General information

NPI: 1548275324
Provider Name (Legal Business Name): KOMOTO PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 ELLINGTON ST
DELANO CA
93215-2621
US

IV. Provider business mailing address

1017 ELLINGTON ST
DELANO CA
93215-2621
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-9489
  • Fax: 661-721-2537
Mailing address:
  • Phone: 661-725-9489
  • Fax: 661-721-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHY34707
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY 34707
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY34707
License Number StateCA

VIII. Authorized Official

Name: MR. BRIAN K. KOMOTO
Title or Position: PRESIDENT/CEO
Credential: PHARM D
Phone: 661-725-9489