1790787265 NPI number — TNL PHARMACY CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790787265 NPI number — TNL PHARMACY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TNL PHARMACY CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790787265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8883 WESTMINSTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92844-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-890-0331
Provider Business Mailing Address Fax Number:
714-890-1860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8883 WESTMINSTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92844-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-890-0331
Provider Business Practice Location Address Fax Number:
714-890-1860
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
TYRONE
Authorized Official Middle Name:
DOTHAI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-890-0331

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY 48960 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1790787265 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHY 48960 . This is a "PHARMACY PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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