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General NPI Number Information
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NPI Number | 1073931887
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Entity Type | Organization
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Legal Business Name | THEO PHARMACEUTICALS INC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 13701 BEACH BLVD STE A2
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City | WESTMINSTER
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State | CA
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Zip | 92683-3201
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Country | US
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Telephone | 714-373-0214
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Fax | 714-373-0839
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Provider Business Mailing Address
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Address Line | 13701 BEACH BLVD STE A2
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City | WESTMINSTER
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State | CA
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Zip | 92683-3201
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Country | US
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Telephone | 714-373-0214
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Fax | 714-373-0839
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Authorized Official
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Title or Position | OWNER
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Name | RAKESH TAMMABATTULA
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Credential |
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Telephone | 347-515-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PH30490
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | NP000794
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | NRP.022668450-03
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 265225
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH03678
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License Number State | NV
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Taxonomy #6
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY53900
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License Number State | CA
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