Provider Demographics
NPI:1992554364
Name:KUBO, TAMI M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAMI
Middle Name:M
Last Name:KUBO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4764
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-1764
Mailing Address - Country:US
Mailing Address - Phone:818-430-5517
Mailing Address - Fax:
Practice Address - Street 1:2040 CAMFIELD AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1502
Practice Address - Country:US
Practice Address - Phone:323-236-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist