MEDICARE: TDSM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY 49856	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093802514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TDSM INC

Provider Business Mailing Address
First Line	:	437 N EUCLID AVE
Second Line	:	SUITE B
City	:	ONTARIO
State	:	CA
Zip	:	91762-3456
Country	:	US
Telephone Number	:	909-983-0999
Fax Number	:	909-983-0888

Provider Business Practice Location Address
First Line	:	437 N EUCLID AVE
Second Line	:	SUITE B
City	:	ONTARIO
State	:	CA
Zip	:	91762-3456
Country	:	US
Telephone Number	:	909-983-0999
Fax Number	:	909-983-0888

Authorized Official
Title or Position	:	CEO
Name	:	NARIMAN ESHAK
Credential	:
Telephone Number	:	909-983-0999

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	12/13/2022

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Directions to “TDSM INC ” Practice Location

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