Provider Demographics
NPI:1871349563
Name:KOMOTO PHARMACY INC.
Entity type:Organization
Organization Name:KOMOTO PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:URMSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-327-7524
Mailing Address - Street 1:2110 TRUXTUN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3703
Mailing Address - Country:US
Mailing Address - Phone:661-327-7524
Mailing Address - Fax:661-327-8793
Practice Address - Street 1:2110 TRUXTUN AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3703
Practice Address - Country:US
Practice Address - Phone:661-327-7524
Practice Address - Fax:661-327-8793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOMOTO PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-24
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy