Provider Demographics
NPI:1164791539
Name:TLH ENTERPRISES INC.
Entity Type:Organization
Organization Name:TLH ENTERPRISES INC.
Other - Org Name:DESERT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-360-3339
Mailing Address - Street 1:41120 WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9596
Mailing Address - Country:US
Mailing Address - Phone:760-360-3339
Mailing Address - Fax:760-345-4800
Practice Address - Street 1:41120 WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9596
Practice Address - Country:US
Practice Address - Phone:760-360-3339
Practice Address - Fax:760-345-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50770333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5642649OtherNCPDP PROVIDER IDENTIFICATION NUMBER