Provider Demographics
NPI:1114464922
Name:TIB PHARMACY INC
Entity Type:Organization
Organization Name:TIB PHARMACY INC
Other - Org Name:TIB NEWARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:NAWEED
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:510-573-0064
Mailing Address - Street 1:5886 MOWRY SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560
Mailing Address - Country:US
Mailing Address - Phone:510-573-0064
Mailing Address - Fax:510-573-0096
Practice Address - Street 1:5886 MOWRY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5367
Practice Address - Country:US
Practice Address - Phone:510-573-0064
Practice Address - Fax:510-573-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336M0003X
CA554353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167968OtherPK