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General NPI Number Information
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NPI Number | 1407829823
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Entity Type | Organization
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Legal Business Name | TEK PHARMACY INCORPORATED
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 21320 HAWTHORNE BLVD STE 112
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City | TORRANCE
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State | CA
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Zip | 90503-5606
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Country | US
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Telephone | 310-543-1331
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Fax | 310-543-0020
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Provider Business Mailing Address
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Address Line | 21320 HAWTHORNE BLVD STE 112
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City | TORRANCE
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State | CA
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Zip | 90503-5606
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Country | US
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Telephone | 310-543-1331
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Fax | 310-543-0020
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Authorized Official
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Title or Position | CEO/PIC
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Name | MR. TIMOTHY T WONG
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Credential | PHARM D
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Telephone | 310-543-1331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY50827
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License Number State | CA
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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 | PHY50827
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License Number State | CA
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