MEDICARE: TOMLYN, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2613859	OTHER	MO	NABP

General Provider Information

NPI Number	:	1821181355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMLYN, INC

Provider Business Mailing Address
First Line	:	7922 MACKENZIE ROAD
Second Line	:
City	:	AFFTON
State	:	MO
Zip	:	63123-2721
Country	:	US
Telephone Number	:	314-638-3535
Fax Number	:	314-638-0351

Provider Business Practice Location Address
First Line	:	7922 MACKENZIE RD
Second Line	:
City	:	AFFTON
State	:	MO
Zip	:	63123-2721
Country	:	US
Telephone Number	:	314-638-3535
Fax Number	:	314-638-0351

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASON ALEXANDER WANG
Credential	:	PHARMD
Telephone Number	:	314-753-8851

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/11/2024

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Directions to “TOMLYN, INC ” Practice Location

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