Healthcare Provider Details

I. General information

NPI: 1619104544
Provider Name (Legal Business Name): TRI-TECH PHARMACEUTICALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BROADWAY NO 105
SANTA MONICA CA
90401-2795
US

IV. Provider business mailing address

910 BROADWAY NO 105
SANTA MONICA CA
90401-2795
US

V. Phone/Fax

Practice location:
  • Phone: 424-268-1780
  • Fax: 424-268-1784
Mailing address:
  • Phone: 424-268-1780
  • Fax: 424-268-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49980
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELEANOR KONG
Title or Position: OWNER, PIC, AO
Credential: RPH
Phone: 424-268-1780