Provider Demographics
NPI:1447736152
Name:TTGI CORP
Entity Type:Organization
Organization Name:TTGI CORP
Other - Org Name:SPARTAN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-337-7131
Mailing Address - Street 1:9609 EMORY AVE
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-4413
Mailing Address - Country:US
Mailing Address - Phone:276-337-7131
Mailing Address - Fax:276-807-7341
Practice Address - Street 1:201 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230
Practice Address - Country:US
Practice Address - Phone:276-807-7106
Practice Address - Fax:276-807-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011465333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy