=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790887503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TGB PHARMACEUTICAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 548 E DEVON AVE
-----------------------------------------------------
City | ELK GROVE VILLAGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60007-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-437-2050
-----------------------------------------------------
Fax | 847-437-2062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 548 E DEVON AVE
-----------------------------------------------------
City | ELK GROVE VILLAGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60007-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-437-2050
-----------------------------------------------------
Fax | 847-437-2062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. STEVE J TONG
-----------------------------------------------------
Credential | PRH
-----------------------------------------------------
Telephone | 847-437-2050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------