Provider Demographics
NPI:1982490090
Name:TABULA RASA HEALTHCARE GROUP, INC
Entity type:Organization
Organization Name:TABULA RASA HEALTHCARE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:216-369-2200
Mailing Address - Street 1:1181 CALIFORNIA AVE # 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1181 CALIFORNIA AVE # 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7253
Practice Address - Country:US
Practice Address - Phone:888-974-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABULA RASA HEALTHCARE GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy