Provider Demographics
NPI:1558363028
Name:TOWN CENTER PHARMACY
Entity Type:Organization
Organization Name:TOWN CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-734-5893
Mailing Address - Street 1:535 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6131
Mailing Address - Country:US
Mailing Address - Phone:559-734-5893
Mailing Address - Fax:559-734-5966
Practice Address - Street 1:535 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6131
Practice Address - Country:US
Practice Address - Phone:559-734-5893
Practice Address - Fax:559-734-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44492183500000X, 1835N1003X, 332B00000X, 332BN1400X, 332BP3500X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility SuppliesGroup - Single Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral NutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA444920Medicaid
CA0609530001Medicare NSC