Healthcare Provider Details

I. General information

NPI: 1093802514
Provider Name (Legal Business Name): TDSM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/13/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 N EUCLID AVE SUITE B
ONTARIO CA
91762-3456
US

IV. Provider business mailing address

437 N EUCLID AVE SUITE B
ONTARIO CA
91762-3456
US

V. Phone/Fax

Practice location:
  • Phone: 909-983-0999
  • Fax: 909-983-0888
Mailing address:
  • Phone: 909-983-0999
  • Fax: 909-983-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 49856
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NARIMAN ESHAK
Title or Position: CEO
Credential:
Phone: 909-983-0999