Provider Demographics
NPI:1356641856
Name:TOM, NORA
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:TOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1830
Mailing Address - Country:US
Mailing Address - Phone:510-524-5881
Mailing Address - Fax:510-524-4220
Practice Address - Street 1:1395 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1830
Practice Address - Country:US
Practice Address - Phone:510-524-5881
Practice Address - Fax:510-524-4220
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist