Tom's Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

5301007164 Issued in MI

Legal business name

TOM'S PHARMACY LLC

Practice address

1462 E Grand River Ave
Portland, MI 48875

Phone

(517) 647-4861

Fax

(517) 647-0078

NPI assigned

Oct 12, 2006

Last updated

Dec 14, 2018By 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

Steve Antaya

Title

Vice President

Phone

(517) 647-4861

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristy Ann Withrow

  • Pharmacist
  • Portland, MI
  • NPI 1629720339
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544745600000",
    "number": "1174612618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1462 E GRAND RIVER AVE",
            "city": "PORTLAND",
            "state": "MI",
            "postal_code": "488751632",
            "telephone_number": "517-647-4861",
            "fax_number": "517-647-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1462 E GRAND RIVER AVE",
            "city": "PORTLAND",
            "state": "MI",
            "postal_code": "48875",
            "telephone_number": "517-647-4861",
            "fax_number": "517-647-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOM'S PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2018-12-14",
        "status": "A",
        "authorized_official_last_name": "ANTAYA",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "517-647-4861"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301007164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4196990",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Portland, MI
• Providers in Portland, MI by specialty
• Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; 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.