MEDICARE: TB 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	333600000X	Pharmacy	PP482801
2	3336C0003X	Community/Retail Pharmacy	PP482801	PA

General Provider Information

NPI Number	:	1902383185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TB PHARMACY INC.

Provider Business Mailing Address
First Line	:	4931 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2215
Country	:	US
Telephone Number	:	215-842-5620
Fax Number	:	215-842-5624

Provider Business Practice Location Address
First Line	:	4931 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2215
Country	:	US
Telephone Number	:	215-842-5620
Fax Number	:	215-842-5624

Authorized Official
Title or Position	:	CEO
Name	:	DR. YONG LI
Credential	:
Telephone Number	:	267-690-1211

Provider Enumeration Date	:	07/20/2018
Last Update Date	:	07/20/2018

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Directions to “TB PHARMACY INC. ” Practice Location

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