Provider Demographics
NPI:1740363100
Name:TOM, GARY ROBERT (PHARMD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ROBERT
Last Name:TOM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2166 HAYES ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1033
Mailing Address - Country:US
Mailing Address - Phone:415-387-3231
Mailing Address - Fax:415-387-2832
Practice Address - Street 1:2166 HAYES ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1033
Practice Address - Country:US
Practice Address - Phone:415-387-3231
Practice Address - Fax:415-387-2832
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472821835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric