Provider Demographics
NPI:1548400435
Name:TLC XPRESS PHARMACY INC
Entity Type:Organization
Organization Name:TLC XPRESS PHARMACY INC
Other - Org Name:TLC XPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-465-2431
Mailing Address - Street 1:10810 WARNER AVE
Mailing Address - Street 2:STE 3-4
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3848
Mailing Address - Country:US
Mailing Address - Phone:714-465-2431
Mailing Address - Fax:714-465-9744
Practice Address - Street 1:10810 WARNER AVE
Practice Address - Street 2:STE 3-4
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3848
Practice Address - Country:US
Practice Address - Phone:714-465-2431
Practice Address - Fax:714-465-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY498373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548400435Medicaid
2119416OtherPK
CA1548400435Medicaid