MEDICARE: TLC PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY51601	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2142774	OTHER		PK

General Provider Information

NPI Number	:	1659392603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC PHARMACY

Provider Business Mailing Address
First Line	:	845 PACIFIC COAST HWY
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3915
Country	:	US
Telephone Number	:	310-798-5400
Fax Number	:	310-798-5448

Provider Business Practice Location Address
First Line	:	845 PACIFIC COAST HWY
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3915
Country	:	US
Telephone Number	:	310-798-5400
Fax Number	:	310-798-5448

Authorized Official
Title or Position	:	PRESIDENT/PIC
Name	:	SUSAN CHOI
Credential	:
Telephone Number	:	310-798-5400

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	01/30/2014

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