Provider Demographics
NPI:1619969201
Name:TH PHARMACEUTICALS, INC.
Entity Type:Organization
Organization Name:TH PHARMACEUTICALS, INC.
Other - Org Name:HOLT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GIANG
Authorized Official - Middle Name:L
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-620-1011
Mailing Address - Street 1:1101 E HOLT AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5800
Mailing Address - Country:US
Mailing Address - Phone:909-620-1011
Mailing Address - Fax:909-620-1011
Practice Address - Street 1:1101 E HOLT AVE
Practice Address - Street 2:SUITE F
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5800
Practice Address - Country:US
Practice Address - Phone:909-620-1011
Practice Address - Fax:909-620-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY37150333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA371500Medicaid