Provider Demographics
NPI:1689047458
Name:TGSC VENTURES, LLC
Entity Type:Organization
Organization Name:TGSC VENTURES, LLC
Other - Org Name:FRONTIER FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:308-529-1224
Mailing Address - Street 1:312 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-1772
Mailing Address - Country:US
Mailing Address - Phone:308-784-3500
Mailing Address - Fax:308-784-3502
Practice Address - Street 1:312 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1772
Practice Address - Country:US
Practice Address - Phone:308-784-3500
Practice Address - Fax:308-784-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31173336C0003X, 3336C0003X
3336C0004X, 3336C0004X
NE30753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155122OtherPK
NE10026649600Medicaid