Provider Demographics
NPI:1477586220
Name:TLS PHARMACY CORP
Entity Type:Organization
Organization Name:TLS PHARMACY CORP
Other - Org Name:CENTEREACH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-303-3088
Mailing Address - Street 1:2155 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4734
Practice Address - Country:US
Practice Address - Phone:631-303-3088
Practice Address - Fax:631-468-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025545333600000X
3336L0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02323128Medicaid
3329768OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3329768OtherOTHER ID NUMBER-COMMERCIAL NUMBER