Provider Demographics
NPI:1851842827
Name:THERACOM, LLC
Entity Type:Organization
Organization Name:THERACOM, LLC
Other - Org Name:THERACOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT LASH CONSULTING GROUP
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-357-3071
Mailing Address - Street 1:3101 GAYLORD PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8655
Mailing Address - Country:US
Mailing Address - Phone:469-365-8241
Mailing Address - Fax:
Practice Address - Street 1:9717 KEY WEST AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3982
Practice Address - Country:US
Practice Address - Phone:888-843-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO5597333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy