Healthcare Provider Details

I. General information

NPI: 1942828587
Provider Name (Legal Business Name): TIB PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5886 MOWRY SCHOOL RD
NEWARK CA
94560-5367
US

IV. Provider business mailing address

5886 MOWRY SCHOOL RD
NEWARK CA
94560-5367
US

V. Phone/Fax

Practice location:
  • Phone: 510-573-0064
  • Fax: 510-573-0096
Mailing address:
  • Phone: 510-573-0064
  • Fax: 510-573-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAWEED MUHAMMAD
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 510-573-0064