MEDICARE: TNL PHARMACY CORPORATION

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	PHY 48960	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PHY 48960	OTHER	CA	PHARMACY PERMIT

General Provider Information

NPI Number	:	1790787265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TNL PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	8883 WESTMINSTER AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-2608
Country	:	US
Telephone Number	:	714-890-0331
Fax Number	:	714-890-1860

Provider Business Practice Location Address
First Line	:	8883 WESTMINSTER AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-2608
Country	:	US
Telephone Number	:	714-890-0331
Fax Number	:	714-890-1860

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TYRONE DOTHAI NGUYEN
Credential	:	PHARM.D
Telephone Number	:	714-890-0331

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/09/2008

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Directions to “TNL PHARMACY CORPORATION ” Practice Location

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