Provider Demographics
NPI:1245390707
Name:TARRYTOWN EXPOCARE SC, INC.
Entity Type:Organization
Organization Name:TARRYTOWN EXPOCARE SC, INC.
Other - Org Name:TARRYTOWN EXPOCARE SC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-617-7313
Mailing Address - Street 1:8500 SHOAL CREEK BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6888
Mailing Address - Country:US
Mailing Address - Phone:803-254-8775
Mailing Address - Fax:866-458-3491
Practice Address - Street 1:137 CEDAR RD STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8869
Practice Address - Country:US
Practice Address - Phone:803-217-1088
Practice Address - Fax:803-239-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC751195Medicaid
2091791OtherPK