Active NPI
Peter Komu
- Pharmacist
- Fort Bragg, CA
National Provider Identifier
1467054890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 83661
- Practice address
- 490 S Main St
Fort Bragg, CA 95437-4806 - Phone
- (707) 964-1848
- NPI assigned
- Nov 10, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 83661 | CA | Primary |
Addresses
Primary practice location
490 S Main St
Fort Bragg, CA 95437-4806
Mailing address
1216 Litchfield LN
Burleson, TX 76028-8226
Phone (646) 644-5236
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 |
|---|---|---|---|
| 83661 | CA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Del Norte LLC | Current | Accepting new patients | |
| Thrifty Payless Inc | Past | Accepting new patients | |
| Thrifty Payless Inc | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Community/Retail Pharmacy
- Crescent City, CA
- NPI 1902791049
-
- Community/Retail Pharmacy
- Winchester, CA
- NPI 1437874062
-
- Community/Retail Pharmacy
- Fort Bragg, CA
- NPI 1679682009
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675382400000",
"number": "1467054890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1216 LITCHFIELD LN",
"city": "BURLESON",
"state": "TX",
"postal_code": "760288226",
"telephone_number": "646-644-5236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "490 S MAIN ST",
"city": "FORT BRAGG",
"state": "CA",
"postal_code": "954374806",
"telephone_number": "707-964-1848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMU",
"first_name": "PETER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-10",
"last_updated": "2023-02-03",
"certification_date": "2023-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "83661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.