Provider Demographics
NPI:1225667132
Name:BORAGNO, THOMAS ALAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:BORAGNO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3266
Mailing Address - Country:US
Mailing Address - Phone:949-689-7731
Mailing Address - Fax:
Practice Address - Street 1:716 E BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92661-1306
Practice Address - Country:US
Practice Address - Phone:949-673-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist