Provider Demographics
NPI:1811317936
Name:THEO PHARMACEUTICALS, INC
Entity type:Organization
Organization Name:THEO PHARMACEUTICALS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-567-7878
Mailing Address - Street 1:18682 BEACH BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2094
Mailing Address - Country:US
Mailing Address - Phone:800-567-7878
Mailing Address - Fax:866-638-6246
Practice Address - Street 1:18682 BEACH BLVD STE 130
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2094
Practice Address - Country:US
Practice Address - Phone:800-567-7878
Practice Address - Fax:866-638-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502551835P1200X, 305S00000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty