Healthcare Provider Details

I. General information

NPI: 1609887231
Provider Name (Legal Business Name): TABULA RASA HEALTHCARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S CANAL ST
SOUTH SAN FRANCISCO CA
94080-4606
US

IV. Provider business mailing address

401 S CANAL ST
SOUTH SAN FRANCISCO CA
94080-4606
US

V. Phone/Fax

Practice location:
  • Phone: 415-387-3231
  • Fax: 650-742-9429
Mailing address:
  • Phone: 415-387-3231
  • Fax: 650-742-9429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY55500
License Number StateCA

VIII. Authorized Official

Name: MICHAEL GREENHALGH
Title or Position: CHIEF OPERATIONG OFFICER
Credential: BS
Phone: 856-840-4867