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General NPI Number Information
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NPI Number | 1508321894
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Entity Type | Individual
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Provider Name | MARK TADAO TAMURA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 100 W LODI AVE
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City | LODI
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State | CA
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Zip | 95240-3582
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Country | US
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Telephone | 209-369-3648
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Fax | 209-369-3104
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Provider Business Mailing Address
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Address Line | 11181 BOESSOW RD
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City | GALT
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State | CA
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Zip | 95632-8321
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Country | US
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Telephone | 209-712-7055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 40586
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License Number State | CA
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