Provider Demographics
NPI:1508909664
Name:TULARE LOCAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:TULARE LOCAL HEALTH CARE DISTRICT
Other - Org Name:TULARE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-688-0821
Mailing Address - Street 1:906 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2210
Mailing Address - Country:US
Mailing Address - Phone:559-684-7979
Mailing Address - Fax:559-684-1157
Practice Address - Street 1:906 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2210
Practice Address - Country:US
Practice Address - Phone:559-684-7979
Practice Address - Fax:559-684-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY464883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5420935Medicaid
5601314OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5155040001Medicare NSC