Healthcare Provider Details

I. General information

NPI: 1689312688
Provider Name (Legal Business Name): TRI TECH RX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BROADWAY STE 105
SANTA MONICA CA
90401-2797
US

IV. Provider business mailing address

910 BROADWAY STE 105
SANTA MONICA CA
90401-2797
US

V. Phone/Fax

Practice location:
  • Phone: 424-252-9224
  • Fax: 424-252-9224
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARA MIKHAELI
Title or Position: CEO/CFO/SEC./DIR./PIC
Credential: PHARMD
Phone: 424-252-9224