Organization
TOM'S PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE ANTAYA (VICE PRESIDENT)
(517) 647-4861
Entity
Organization
Contact information
Practice address
1462 E GRAND RIVER AVE, PORTLAND, MI 48875
(517) 647-4861
(517) 647-0078
Mailing address
1462 E GRAND RIVER AVE, PORTLAND, MI 48875-1632
(517) 647-4861
(517) 647-0078
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5301007164
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4196990
—
MI
Enumeration date
10/12/2006
Last updated
12/14/2018
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