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Contact Information

TOM'S PHARMACY LLC
1462 E GRAND RIVER AVE
PORTLAND, MI48875
 Phone: 517-647-4861
 Fax: 517-647-0078
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for TOM'S PHARMACY LLC

NPI Number 1174612618
LBN Legal business name TOM'S PHARMACY LLC
Authorized official STEVE ANTAYA - (VICE PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/12/2006
Last updated 12/14/2018 - About 7 years ago
Identifiers
MI License # 5301007164
MI Medicaid 4196990
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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