Provider Demographics
NPI:1619104544
Name:TRI-TECH PHARMACEUTICALS
Entity Type:Organization
Organization Name:TRI-TECH PHARMACEUTICALS
Other - Org Name:TRI-TECH PHARMACEUTICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:424-268-1780
Mailing Address - Street 1:910 BROADWAY
Mailing Address - Street 2:NO 105
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2795
Mailing Address - Country:US
Mailing Address - Phone:424-268-1780
Mailing Address - Fax:424-268-1784
Practice Address - Street 1:910 BROADWAY
Practice Address - Street 2:NO 105
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2795
Practice Address - Country:US
Practice Address - Phone:424-268-1780
Practice Address - Fax:424-268-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CAPHY499803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120939OtherPK