Provider Demographics
NPI:1346776838
Name:TMC 62 LLC
Entity Type:Organization
Organization Name:TMC 62 LLC
Other - Org Name:THE MODERN CHEMIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:URRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-689-2007
Mailing Address - Street 1:62 WATER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1129
Mailing Address - Country:US
Mailing Address - Phone:347-689-2007
Mailing Address - Fax:347-294-4014
Practice Address - Street 1:62 WATER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1129
Practice Address - Country:US
Practice Address - Phone:347-689-2007
Practice Address - Fax:347-294-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035255333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy