Provider Demographics
NPI:1184766750
Name:HELEN L. TAN, RPH, INC
Entity type:Organization
Organization Name:HELEN L. TAN, RPH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-668-1766
Mailing Address - Street 1:326 N VERMONT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3511
Mailing Address - Country:US
Mailing Address - Phone:323-668-1766
Mailing Address - Fax:323-668-1348
Practice Address - Street 1:326 N VERMONT AVE STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3511
Practice Address - Country:US
Practice Address - Phone:323-668-1766
Practice Address - Fax:323-668-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA366250Medicaid
CA5542240001Medicare ID - Type UnspecifiedMEDICARE NUMBER