Provider Demographics
NPI:1639724495
Name:CAMACHO, THOMAS TOMOHIKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:TOMOHIKO
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 W NOB HILL BLVD APT 259
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3644
Mailing Address - Country:US
Mailing Address - Phone:360-550-7432
Mailing Address - Fax:
Practice Address - Street 1:5702 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3040
Practice Address - Country:US
Practice Address - Phone:509-965-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60960372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist