Provider Demographics
NPI:1164735080
Name:TC MEDICAL PHARMACY CORP
Entity Type:Organization
Organization Name:TC MEDICAL PHARMACY CORP
Other - Org Name:TC MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:951-371-2003
Mailing Address - Street 1:760 WASHBURN AVE
Mailing Address - Street 2:#1
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3303
Mailing Address - Country:US
Mailing Address - Phone:951-371-2003
Mailing Address - Fax:951-371-2002
Practice Address - Street 1:760 WASHBURN AVE
Practice Address - Street 2:#1
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3303
Practice Address - Country:US
Practice Address - Phone:951-371-2003
Practice Address - Fax:951-371-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50347333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50347OtherCALIFORNIA STATE BOARD OF PHARMACY
CAPHY 50347OtherCALIFORNIA STATE BOARD OF PHARMACY