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NPI Code Detail

MEDICARE: ERNEST TOM JR.

MEDICARE: ERNEST TOM JR.
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
1183500000XPharmacistCA51194CA

General Provider Information

NPI Number : 1447676515
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERNEST TOM JR.
Provider Business Mailing Address
First Line : 1745 GARFIELD AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-4923
Country : US
Telephone Number : 626-799-2926
Fax Number : 626-799-2183
Provider Business Practice Location Address
First Line : 1745 GARFIELD AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-4923
Country : US
Telephone Number : 626-799-2926
Fax Number : 626-799-2183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2014
Last Update Date : 03/12/2014

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