Organization
KEVIN S TOM
Active
Other names
Copperopolis Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN TOM PHARMD (OWNER/ RPH)
(209) 785-8787
Entity
Organization
Contact information
Practice address
49 COSMIC CT STE C, COPPEROPOLIS, CA 95228-9300
(209) 785-8787
(209) 785-8783
Mailing address
PO BOX 699, COPPEROPOLIS, CA 95228-0699
(209) 785-8787
(209) 785-8783
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51616
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141950
PK
—
Enumeration date
09/06/2013
Last updated
10/16/2015
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