Provider Demographics
NPI:1184600496
Name:MCCOMB, DENNIS MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:MCCOMB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19444 ROSEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-9032
Mailing Address - Country:US
Mailing Address - Phone:209-334-2174
Mailing Address - Fax:
Practice Address - Street 1:115 LAKEWOOD MALL
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2963
Practice Address - Country:US
Practice Address - Phone:209-368-2788
Practice Address - Fax:209-368-4951
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28791OtherPHARMACY LICENCE NUMBER