Active NPI
Thomas Combahee
- Pharmacist
- Glendale, AZ
National Provider Identifier
1073927232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S019376
- Practice address
- 5125 W Olive Ave
Glendale, AZ 85302-4204 - Phone
- (623) 931-0882
- NPI assigned
- Jun 16, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S019376 | AZ | Primary |
| Pharmacist | 183500000X | 70622 | CA |
Addresses
Primary practice location
5125 W Olive Ave
Glendale, AZ 85302-4204
Mailing address
13300 N 88TH Ave Apt 1117
Peoria, AZ 85381-3832
Phone (714) 655-9073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S019376 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arizona CVS Stores LLC | Past | Accepting new patients | |
| Arizona CVS Stores LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1073927232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13300 N 88TH AVE APT 1117",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853813832",
"telephone_number": "714-655-9073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5125 W OLIVE AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853024204",
"telephone_number": "623-931-0882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COMBAHEE",
"first_name": "THOMAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-16",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S019376",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "70622",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.