Provider Demographics
NPI:1164536314
Name:TILLEY APOTHECARIES INC.
Entity Type:Organization
Organization Name:TILLEY APOTHECARIES INC.
Other - Org Name:ZWEBER APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:562-862-8416
Mailing Address - Street 1:11411 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE #107
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5003
Mailing Address - Country:US
Mailing Address - Phone:562-923-1256
Mailing Address - Fax:562-923-1847
Practice Address - Street 1:11411 BROOKSHIRE AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5003
Practice Address - Country:US
Practice Address - Phone:562-923-1256
Practice Address - Fax:562-923-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY306553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0527804OtherNCPDP
CA0527804OtherNCPDP