Theo Pharmaceuticals Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY53900 Issued in CA

Legal business name

THEO PHARMACEUTICALS INC

Doing business as

Theo Pharmacy

Practice address

13701 Beach Blvd
Ste A2
Westminster, CA 92683-3201

Phone

(714) 373-0214

Fax

(714) 373-0839

NPI assigned

Mar 31, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rakesh Tammabattula

Title

Owner

Phone

(347) 515-6789

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 1

• THEO PHARMACY Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Koong

  • Pharmacist
  • Westminster, CA
  • NPI 1649715152
  NPD (past)
• Jacqueline T Nguyen, PHARMACIST

  • Pharmacist
  • Westminster, CA
  • NPI 1629421383
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1073931887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13701 BEACH BLVD STE A2",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926833201",
            "telephone_number": "714-373-0214",
            "fax_number": "714-373-0839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13701 BEACH BLVD",
            "address_2": "STE A2",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926833201",
            "telephone_number": "714-373-0214",
            "fax_number": "714-373-0839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEO PHARMACEUTICALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-31",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "TAMMABATTULA",
        "authorized_official_first_name": "RAKESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-515-6789"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "265225",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "NP000794",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "NRP.022668450-03",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY53900",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NV",
            "license": "PH03678",
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "FL",
            "license": "PH30490",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8968740",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2162079",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THEO PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Westminster, CA
• Providers in Westminster, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.