Provider Demographics
NPI:1659794741
Name:TCS LABS LLC
Entity Type:Organization
Organization Name:TCS LABS LLC
Other - Org Name:THE COMPOUNDING SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:WANDERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-558-7046
Mailing Address - Street 1:1289 DEMING WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2007
Mailing Address - Country:US
Mailing Address - Phone:800-558-7046
Mailing Address - Fax:888-898-7412
Practice Address - Street 1:4000 PARK ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4034
Practice Address - Country:US
Practice Address - Phone:727-381-9799
Practice Address - Fax:727-347-2050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORE HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH273313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy