Healthcare Provider Details

I. General information

NPI: 1518992031
Provider Name (Legal Business Name): TOWER PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12641 BENTLEY ST
WATERFORD CA
95386-9011
US

IV. Provider business mailing address

12641 BENTLEY ST
WATERFORD CA
95386-9011
US

V. Phone/Fax

Practice location:
  • Phone: 209-874-2138
  • Fax: 209-874-9853
Mailing address:
  • Phone: 209-874-2138
  • Fax: 209-874-9853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50624
License Number StateCA

VIII. Authorized Official

Name: MR. DARIN LEON NELLE
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 209-874-2138