Active NPI
Clementine F Fomba
- Pharmacist
- Tuba City, AZ
National Provider Identifier
1689446239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19686
- Practice address
- 167 North Main Street
Tuba City, AZ 86045 - Phone
- (928) 283-2760
- NPI assigned
- Oct 26, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 19686 | MD | Primary |
Addresses
Primary practice location
167 North Main Street
Tuba City, AZ 86045
Mailing address
PO Box 600
Tuba City, AZ 86045-0600
Phone (928) 283-2760
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 |
|---|---|---|---|
| 19686 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698278400000",
"number": "1689446239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 600",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "860450600",
"telephone_number": "928-283-2760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 NORTH MAIN STREET",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "86045",
"telephone_number": "928-283-2760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMBA",
"first_name": "CLEMENTINE",
"middle_name": "F",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-26",
"last_updated": "2023-10-26",
"certification_date": "2023-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "19686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tuba City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.