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General NPI Number Information
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NPI Number | 1699030288
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Entity Type | Organization
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Legal Business Name | TMB CORPORATION
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 235 W FLETCHER ST
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City | HAXTUN
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State | CO
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Zip | 80731-2737
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Country | US
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Telephone | 970-774-3784
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Fax | 970-774-3785
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Provider Business Mailing Address
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Address Line | 235 W FLETCHER ST
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City | HAXTUN
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State | CO
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Zip | 80731-2737
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Country | US
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Telephone | 970-474-3411
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PHARMACIST
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Name | MELISSA BUMGARDNER
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Credential |
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Telephone | 970-474-3672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1680000002
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License Number State | CO
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