Provider Demographics
NPI:1164702122
Name:TORRANCE PHARMACY INC
Entity Type:Organization
Organization Name:TORRANCE PHARMACY INC
Other - Org Name:TORRANCE PHARMACY & COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TABATABAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-539-6200
Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:424-250-1701
Mailing Address - Fax:424-250-1704
Practice Address - Street 1:23600 TELO AVE STE 155
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4005
Practice Address - Country:US
Practice Address - Phone:424-250-1701
Practice Address - Fax:424-250-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506643336C0003X
3336L0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131566OtherPK
CA1164702122Medicaid