Provider Demographics
NPI:1407829823
Name:TEK PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:TEK PHARMACY INCORPORATED
Other - Org Name:DEL AMO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-543-1331
Mailing Address - Street 1:21320 HAWTHORNE BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5606
Mailing Address - Country:US
Mailing Address - Phone:310-543-1331
Mailing Address - Fax:310-543-0020
Practice Address - Street 1:21320 HAWTHORNE BLVD
Practice Address - Street 2:STE 112
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5606
Practice Address - Country:US
Practice Address - Phone:310-543-1331
Practice Address - Fax:310-543-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50827333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50827OtherCALIFORNIA STATE BOARD OF PHARMACY
0512156OtherNCPDP PROVIDER IDENTIFICATION NUMBER