Healthcare Provider Details

I. General information

NPI: 1659392603
Provider Name (Legal Business Name): TLC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 PACIFIC COAST HWY
HERMOSA BEACH CA
90254-3915
US

IV. Provider business mailing address

845 PACIFIC COAST HWY
HERMOSA BEACH CA
90254-3915
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-5400
  • Fax: 310-798-5448
Mailing address:
  • Phone: 310-798-5400
  • Fax: 310-798-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51601
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN CHOI
Title or Position: PRESIDENT/PIC
Credential:
Phone: 310-798-5400