MEDICARE: TORRANCE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	50664	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2131566	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164702122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TORRANCE PHARMACY INC

Provider Business Mailing Address
First Line	:	23600 TELO AVE
Second Line	:	SUITE 155
City	:	TORRANCE
State	:	CA
Zip	:	90505-4035
Country	:	US
Telephone Number	:	424-250-1701
Fax Number	:	424-250-1704

Provider Business Practice Location Address
First Line	:	23600 TELO AVE STE 155
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-4005
Country	:	US
Telephone Number	:	424-250-1701
Fax Number	:	424-250-1704

Authorized Official
Title or Position	:	PRESIDENT/PIC
Name	:	AMIR TABATABAI
Credential	:	PHARM.D.
Telephone Number	:	310-539-6200

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	01/31/2022

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Directions to “TORRANCE PHARMACY INC ” Practice Location

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