Provider Demographics
NPI:1760806178
Name:TESTFORTHAT, LLC
Entity Type:Organization
Organization Name:TESTFORTHAT, LLC
Other - Org Name:REJUVENX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:CANIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-325-9694
Mailing Address - Street 1:210 BRENDAN WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3515
Mailing Address - Country:US
Mailing Address - Phone:864-325-9694
Mailing Address - Fax:
Practice Address - Street 1:210 BRENDAN WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3515
Practice Address - Country:US
Practice Address - Phone:864-325-9694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC151213336C0003X
SC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy