Healthcare Provider Details

I. General information

NPI: 1194471425
Provider Name (Legal Business Name): TIB PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MCHENRY AVE STE 205
ESCALON CA
95320-9473
US

IV. Provider business mailing address

5886 MOWRY SCHOOL RD # TEAM0002
NEWARK CA
94560-5367
US

V. Phone/Fax

Practice location:
  • Phone: 209-900-1977
  • Fax: 209-900-1774
Mailing address:
  • Phone: 209-900-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAWEED MUHAMMAD
Title or Position: CEO
Credential:
Phone: 510-902-8080