Provider Demographics
NPI:1497057103
Name:TMRX VENTURES LLC
Entity Type:Organization
Organization Name:TMRX VENTURES LLC
Other - Org Name:DR PHILLIPS SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MGR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-361-3049
Mailing Address - Street 1:7649 TURKEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5222
Mailing Address - Country:US
Mailing Address - Phone:407-903-1544
Mailing Address - Fax:407-903-1520
Practice Address - Street 1:7649 TURKEY LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5222
Practice Address - Country:US
Practice Address - Phone:407-903-1544
Practice Address - Fax:407-903-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH250633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127770OtherPK
FL003092700Medicaid