Provider Demographics
NPI:1861229254
Name:KOMOTO PHARMACY, INC.
Entity type:Organization
Organization Name:KOMOTO PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-427-4612
Mailing Address - Street 1:1017 ELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2621
Mailing Address - Country:US
Mailing Address - Phone:661-725-9489
Mailing Address - Fax:
Practice Address - Street 1:1017 ELLINGTON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2621
Practice Address - Country:US
Practice Address - Phone:661-725-9489
Practice Address - Fax:661-721-2537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOMOTO PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy