Provider Demographics
NPI:1245754605
Name:TPC COMPOUNDING PHARMACY,LLC
Entity Type:Organization
Organization Name:TPC COMPOUNDING PHARMACY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RIENZI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-266-6095
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-1287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9275 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9140
Practice Address - Country:US
Practice Address - Phone:843-266-6095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy