Provider Demographics
NPI:1366083198
Name:TYDUS GROUP
Entity type:Organization
Organization Name:TYDUS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:714-707-5115
Mailing Address - Street 1:431 N TUSTIN AVE STE 431-C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3821
Mailing Address - Country:US
Mailing Address - Phone:714-707-5115
Mailing Address - Fax:714-551-6822
Practice Address - Street 1:431 N TUSTIN AVE STE 431-C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3821
Practice Address - Country:US
Practice Address - Phone:714-707-5115
Practice Address - Fax:714-551-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57437OtherBOARD OF PHARMACY PERMIT