Provider Demographics
NPI:1184107500
Name:TAT PHARMACY, INC
Entity type:Organization
Organization Name:TAT PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-878-3189
Mailing Address - Street 1:9153 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1308
Mailing Address - Country:US
Mailing Address - Phone:714-583-8402
Mailing Address - Fax:714-733-5668
Practice Address - Street 1:9153 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1308
Practice Address - Country:US
Practice Address - Phone:714-583-8402
Practice Address - Fax:714-733-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56183OtherBOARD OF PHARMACY PERMIT