Provider Demographics
NPI:1033966254
Name:TOMECHKO, PAUL FRANCIS (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FRANCIS
Last Name:TOMECHKO
Suffix:
Gender:U
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1295 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1683
Mailing Address - Country:US
Mailing Address - Phone:208-785-1311
Mailing Address - Fax:208-785-7071
Practice Address - Street 1:1295 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1683
Practice Address - Country:US
Practice Address - Phone:208-785-1311
Practice Address - Fax:208-785-7071
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP11063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist