Organization
TED'S VILLAGE PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NGUYEN TAM PHAM PHAM.D (CEO)
(650) 349-1373
Entity
Organization
Contact information
Practice address
29 W 25TH AVE, SAN MATEO, CA 94403-2236
(650) 349-1373
(650) 349-1745
Mailing address
29 W 25TH AVE, SAN MATEO, CA 94403-2236
(650) 349-1373
(650) 349-1745
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY46796
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0546753
NCPDP
—
05
—
PHA467960
—
CA
Enumeration date
01/27/2007
Last updated
08/22/2020
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