Provider Demographics
NPI:1194279604
Name:T & G HEALTHCARE, INC.
Entity type:Organization
Organization Name:T & G HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH-LONG
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-586-1700
Mailing Address - Street 1:24031 MARGUERITE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1929
Mailing Address - Country:US
Mailing Address - Phone:949-586-1700
Mailing Address - Fax:949-586-4683
Practice Address - Street 1:3948 PECK RD
Practice Address - Street 2:STE. A1
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2255
Practice Address - Country:US
Practice Address - Phone:626-448-2507
Practice Address - Fax:626-448-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 544793336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 54479OtherBOARD OF PHARMACY