Kevin S Tom

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY51616 Issued in CA

Legal business name

KEVIN S TOM

Doing business as

Copperopolis Pharmacy

Practice address

49 Cosmic CT Ste C
Copperopolis, CA 95228-9300

Phone

(209) 785-8787

Fax

(209) 785-8783

NPI assigned

Sep 6, 2013

Last updated

Oct 16, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Tom, PHARMD

Title

Owner/ RPH

Phone

(209) 785-8787

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Copperopolis Pharmacy Doing business as

Tax ID family

Copperopolis Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Copperopolis Pharmacy

  • Community/Retail Pharmacy
  • Copperopolis, CA
  • NPI 1164529459
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444953600000",
    "number": "1093140238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "COPPEROPOLIS",
            "state": "CA",
            "postal_code": "952280699",
            "telephone_number": "209-785-8787",
            "fax_number": "209-785-8783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 COSMIC CT STE C",
            "city": "COPPEROPOLIS",
            "state": "CA",
            "postal_code": "952289300",
            "telephone_number": "209-785-8787",
            "fax_number": "209-785-8783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN S TOM",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-06",
        "last_updated": "2015-10-16",
        "status": "A",
        "authorized_official_last_name": "TOM",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER/ RPH",
        "authorized_official_telephone_number": "209-785-8787",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY51616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2141950",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copperopolis Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Polly Chrysanthemum Dodds
• Emotional and Behavioral Helath Services
• Richard Wesley French, DDS
• Ocean Reid Grohman
• Kirandeep Kaur, DDS
• Kirandeep Kaur DDS Inc
• Heather Koren Mann, ARRT (CT) CRT
• Jennifer Ellen Mann
• Mark Twain Medical Center (Family Medical Center - Copperopolis)
• Mental Health and Recovery Counseling Education and Training (Mhrcet)

• Community/Retail Pharmacy in Copperopolis, CA
• Providers in Copperopolis, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.