Provider Demographics
NPI:1003456005
Name:TGSC VENTURES, LLC
Entity Type:Organization
Organization Name:TGSC VENTURES, LLC
Other - Org Name:FRONTIER FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:GAVIN
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-529-1224
Mailing Address - Street 1:540 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2456
Mailing Address - Country:US
Mailing Address - Phone:308-872-5231
Mailing Address - Fax:308-872-2377
Practice Address - Street 1:540 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2456
Practice Address - Country:US
Practice Address - Phone:308-872-5231
Practice Address - Fax:308-872-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026649601Medicaid