MEDICARE: TAT 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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56183	OTHER	CA	BOARD OF PHARMACY PERMIT

General Provider Information

NPI Number	:	1184107500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAT PHARMACY, INC

Provider Business Mailing Address
First Line	:	9153 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1308
Country	:	US
Telephone Number	:	714-583-8402
Fax Number	:	714-733-5668

Provider Business Practice Location Address
First Line	:	9153 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1308
Country	:	US
Telephone Number	:	714-583-8402
Fax Number	:	714-733-5668

Authorized Official
Title or Position	:	SECRETARY/OWNER/AUTHORIZED OFFICIAL
Name	:	VY T HUA
Credential	:
Telephone Number	:	714-878-3189

Provider Enumeration Date	:	09/11/2018
Last Update Date	:	03/03/2021

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Directions to “TAT PHARMACY, INC ” Practice Location

Language	Start Address	Practice Location

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