Basic Information
| Provider Information | |||||||||
| NPI: | 1932620077 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TMD HEALTH LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GOOD HEALTH PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 17942 SKY PARK CIR STE B | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926144431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495066001 | ||||||||
| FaxNumber: | 8003031247 | ||||||||
| Practice Location | |||||||||
| Address1: | 17942 SKY PARK CIR STE B | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926144431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495066001 | ||||||||
| FaxNumber: | 8003031247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | DO | ||||||||
| AuthorizedOfficialFirstName: | TIEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9495066001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 55555 | CA | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.