Provider Demographics
NPI:1992044705
Name:THERACOM LLC
Entity Type:Organization
Organization Name:THERACOM LLC
Other - Org Name:THERACOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR PHARMACY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:EILER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:469-365-8338
Mailing Address - Street 1:5025 PLANO PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:469-365-8245
Mailing Address - Fax:469-365-8274
Practice Address - Street 1:345 INTERNATIONAL BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKS
Practice Address - State:KY
Practice Address - Zip Code:40109-6202
Practice Address - Country:US
Practice Address - Phone:877-654-7812
Practice Address - Fax:469-365-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07549333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy