Provider Demographics
NPI:1477605525
Name:TEPS LLC
Entity Type:Organization
Organization Name:TEPS LLC
Other - Org Name:TEPS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SP
Authorized Official - Prefix:
Authorized Official - First Name:JINNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-222-0697
Mailing Address - Street 1:1563 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1563 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3127
Practice Address - Country:US
Practice Address - Phone:718-676-0697
Practice Address - Fax:718-676-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0281193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3352957OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY5930850001Medicare NSC