Provider Demographics
NPI:1134130727
Name:TMP PHARMACY LLC
Entity Type:Organization
Organization Name:TMP PHARMACY LLC
Other - Org Name:TMP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-290-7741
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:SUITE 48
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4595
Mailing Address - Country:US
Mailing Address - Phone:281-290-7741
Mailing Address - Fax:281-290-7752
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:SUITE 48
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4595
Practice Address - Country:US
Practice Address - Phone:281-290-7741
Practice Address - Fax:281-290-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX225923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098633OtherPK
TX145289Medicaid