Healthcare Provider Details

I. General information

NPI: 1164536314
Provider Name (Legal Business Name): TILLEY APOTHECARIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 BROOKSHIRE AVE SUITE #107
DOWNEY CA
90241-5003
US

IV. Provider business mailing address

11411 BROOKSHIRE AVE SUITE #107
DOWNEY CA
90241-5003
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-1256
  • Fax: 562-923-1847
Mailing address:
  • Phone: 562-923-1256
  • Fax: 562-923-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY30655
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN E. TILLEY
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 562-862-8416