Provider Demographics
NPI:1205199585
Name:MAEZ, TOM JOE (PHARMD)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:JOE
Last Name:MAEZ
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 1:7535 N PALM AVE
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5504
Mailing Address - Country:US
Mailing Address - Phone:559-432-9800
Mailing Address - Fax:559-432-2349
Practice Address - Street 1:7535 N PALM AVE
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5504
Practice Address - Country:US
Practice Address - Phone:559-432-9800
Practice Address - Fax:559-432-2349
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist