Provider Demographics
NPI:1245582089
Name:TPS RX
Entity Type:Organization
Organization Name:TPS RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRION
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-608-4995
Mailing Address - Street 1:2250 SHIPYARD BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8070
Mailing Address - Country:US
Mailing Address - Phone:910-442-2056
Mailing Address - Fax:
Practice Address - Street 1:2250 SHIPYARD BLVD STE 11
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8070
Practice Address - Country:US
Practice Address - Phone:910-442-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11354333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy