Thomas D Reidenbach

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHY442640 Issued in CA

Legal business name

THOMAS D REIDENBACH

Doing business as

Myers Apothecary Shop

Practice address

238 Hospital Dr Ste a
Ukiah, CA 95482-4559

Phone

(707) 468-8991

Fax

(707) 468-5272

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Dale Reidenbach

Title

Owner

Phone

(707) 468-8991

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Myers Apothecary Shop Doing business as

Locations

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277942400000",
    "number": "1629158308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 HOSPITAL DR STE A",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824559",
            "telephone_number": "707-468-8991",
            "fax_number": "707-468-5272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 HOSPITAL DR STE A",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824559",
            "telephone_number": "707-468-8991",
            "fax_number": "707-468-5272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS D REIDENBACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2010-07-01",
        "status": "A",
        "authorized_official_last_name": "REIDENBACH",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-468-8991",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY442640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHY442640",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Myers Apothecary Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gary Thomas
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• Robin Thomas

• Pharmacy in Ukiah, CA
• Providers in Ukiah, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2010; 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.