Provider Demographics
NPI:1952398117
Name:TAO DAN PHARMACY, INC.
Entity type:Organization
Organization Name:TAO DAN PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:THU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-323-3864
Mailing Address - Street 1:15342 MONTPELLIER AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3130
Mailing Address - Country:US
Mailing Address - Phone:714-323-3864
Mailing Address - Fax:
Practice Address - Street 1:15342 MONTPELLIER AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3130
Practice Address - Country:US
Practice Address - Phone:714-323-3864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY47231333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA472310Medicaid
CA5513850001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #