1992044705 NPI number — THERACOM LLC

Table of content: (NPI 1992044705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992044705 NPI number — THERACOM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERACOM LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THERACOM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992044705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5025 PLANO PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-365-8245
Provider Business Mailing Address Fax Number:
469-365-8274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 INTERNATIONAL BLVD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BROOKS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40109-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-654-7812
Provider Business Practice Location Address Fax Number:
469-365-8274
Provider Enumeration Date:
02/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EILER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
MAX
Authorized Official Title or Position:
SR. DIRECTOR PHARMACY SERVICES
Authorized Official Telephone Number:
469-365-8338

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  P07549 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)