Provider Demographics
NPI:1790887503
Name:TGB PHARMACEUTICAL, INC
Entity Type:Organization
Organization Name:TGB PHARMACEUTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:PRH
Authorized Official - Phone:847-437-2050
Mailing Address - Street 1:548 E DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-4669
Mailing Address - Country:US
Mailing Address - Phone:847-437-2050
Mailing Address - Fax:847-437-2062
Practice Address - Street 1:548 E DEVON AVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-4669
Practice Address - Country:US
Practice Address - Phone:847-437-2050
Practice Address - Fax:847-437-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid