Provider Demographics
NPI:1831743632
Name:TTGI2 LLC
Entity type:Organization
Organization Name:TTGI2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-321-0088
Mailing Address - Street 1:PO BOX 1439
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-1439
Mailing Address - Country:US
Mailing Address - Phone:276-321-0088
Mailing Address - Fax:276-807-7341
Practice Address - Street 1:426 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293
Practice Address - Country:US
Practice Address - Phone:276-321-0088
Practice Address - Fax:276-807-7341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TTGI CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-30
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy