Provider Demographics
NPI:1023187978
Name:TOMAR LLC
Entity Type:Organization
Organization Name:TOMAR LLC
Other - Org Name:TOMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-387-7080
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321-0087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 N PLAZA ST
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321-2464
Practice Address - Country:US
Practice Address - Phone:520-387-7080
Practice Address - Fax:520-387-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY02687333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ312439Medicaid
0309826OtherOTHER ID NUMBER-COMMERCIAL NUMBER