Organization
KOMOTO PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN K. KOMOTO PHARM D (PRESIDENT/CEO)
(661) 725-9489
Entity
Organization
Contact information
Practice address
1017 ELLINGTON ST, DELANO, CA 93215-2621
(661) 725-9489
(661) 721-2537
Mailing address
1017 ELLINGTON ST, DELANO, CA 93215-2621
(661) 725-9489
(661) 721-2537
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PHY 34707
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHY34707
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY34707
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHA347070
MEDI-CAL
CA
Enumeration date
07/30/2006
Last updated
06/30/2020
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