Provider Demographics
NPI:1689664740
Name:TOMMIE'S MEDICAL CENTER PHARMACY
Entity Type:Organization
Organization Name:TOMMIE'S MEDICAL CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:THOMASINE
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:KALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-993-9370
Mailing Address - Street 1:1041 E YORBA LINDA BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3728
Mailing Address - Country:US
Mailing Address - Phone:714-993-9370
Mailing Address - Fax:714-572-9453
Practice Address - Street 1:1041 E YORBA LINDA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3728
Practice Address - Country:US
Practice Address - Phone:714-993-9370
Practice Address - Fax:714-572-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY33273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA207790Medicaid
CAPHA207790Medicaid