Healthcare Provider Details

I. General information

NPI: 1023117975
Provider Name (Legal Business Name): TOMER DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3462 W MT WHITNEY AVE
RIVERDALE CA
93656-9401
US

IV. Provider business mailing address

PO BOX 157 P.O. BOX 157
RIVERDALE CA
93656-0157
US

V. Phone/Fax

Practice location:
  • Phone: 559-867-3013
  • Fax: 559-867-2015
Mailing address:
  • Phone: 559-867-3013
  • Fax: 559-867-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY22990
License Number StateCA

VIII. Authorized Official

Name: DENNIS SMITH
Title or Position: OWNER
Credential:
Phone: 559-867-3013