Provider Demographics
NPI:1609887231
Name:TABULA RASA HEALTHCARE GROUP, INC.
Entity Type:Organization
Organization Name:TABULA RASA HEALTHCARE GROUP, INC.
Other - Org Name:CAREKINESIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONG OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENHALGH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:856-840-4867
Mailing Address - Street 1:401 S CANAL ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4606
Mailing Address - Country:US
Mailing Address - Phone:415-387-3231
Mailing Address - Fax:650-742-9429
Practice Address - Street 1:401 S CANAL ST
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4606
Practice Address - Country:US
Practice Address - Phone:415-387-3231
Practice Address - Fax:650-742-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY555003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609887231Medicaid
CAPHA451080Medicaid
2094532OtherPK