Organization
TAN THAI INC
Active
Other names
OLD VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TAN THAI (PRESIDENT, OWNER, PIC, AO)
(614) 853-3498
Entity
Organization
Contact information
Practice address
978 GALLOWAY RD, GALLOWAY, OH 43119-8293
(614) 853-3498
(614) 853-4022
Mailing address
978 GALLOWAY RD, GALLOWAY, OH 43119-8293
(614) 853-3498
(614) 853-4022
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021330450
OH
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2078707
PK
—
05
—
2332738
—
OH
Enumeration date
09/20/2006
Last updated
12/19/2019
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