Provider Demographics
NPI:1891219564
Name:TD HEALTHCARE 2 LLC
Entity Type:Organization
Organization Name:TD HEALTHCARE 2 LLC
Other - Org Name:TWIN OAKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-244-9882
Mailing Address - Street 1:10113 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8254
Mailing Address - Country:US
Mailing Address - Phone:813-244-9882
Mailing Address - Fax:806-783-0883
Practice Address - Street 1:3436 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2830
Practice Address - Country:US
Practice Address - Phone:806-799-3636
Practice Address - Fax:806-795-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278153336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148536Medicaid