Provider Demographics
NPI:1801410642
Name:TPS COMPOUNDING AND LONG TERM CARE PHARMACY LLC
Entity Type:Organization
Organization Name:TPS COMPOUNDING AND LONG TERM CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:RANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-206-1630
Mailing Address - Street 1:5223 MONTICELLO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8236
Mailing Address - Country:US
Mailing Address - Phone:757-603-1245
Mailing Address - Fax:
Practice Address - Street 1:4097 IRONBOUND RD STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2676
Practice Address - Country:US
Practice Address - Phone:757-206-1630
Practice Address - Fax:757-612-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-06
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy