=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578923025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENCARE PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2016
-----------------------------------------------------
Last Update Date | 04/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 LONG BEACH BLVD STE 3
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90813-4417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-624-8886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20358
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90801-3358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-624-8886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JACQUELINE VU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-624-8886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 53618
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------