Provider Demographics
NPI:1164402921
Name:TOMKIY, INC
Entity Type:Organization
Organization Name:TOMKIY, INC
Other - Org Name:PERVELERS PHARMACY & HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:PROF
Authorized Official - First Name:KIYOSHI
Authorized Official - Middle Name:KIY
Authorized Official - Last Name:TAKEMOTO
Authorized Official - Suffix:I
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-287-6181
Mailing Address - Street 1:201 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1622
Mailing Address - Country:US
Mailing Address - Phone:626-287-6181
Mailing Address - Fax:626-287-9706
Practice Address - Street 1:201 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1622
Practice Address - Country:US
Practice Address - Phone:626-287-6181
Practice Address - Fax:626-287-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA303150Medicaid
CAPHA303150Medicaid