Healthcare Provider Details

I. General information

NPI: 1073931887
Provider Name (Legal Business Name): THEO PHARMACEUTICALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 BEACH BLVD STE A2
WESTMINSTER CA
92683-3201
US

IV. Provider business mailing address

13701 BEACH BLVD STE A2
WESTMINSTER CA
92683-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-373-0214
  • Fax: 714-373-0839
Mailing address:
  • Phone: 714-373-0214
  • Fax: 714-373-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number265225
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNP000794
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNRP.022668450-03
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY53900
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH03678
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH30490
License Number StateFL

VIII. Authorized Official

Name: RAKESH TAMMABATTULA
Title or Position: OWNER
Credential:
Phone: 347-515-6789