Healthcare Provider Details

I. General information

NPI: 1992044705
Provider Name (Legal Business Name): THERACOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 INTERNATIONAL BLVD. SUITE 200
BROOKS KY
40109-6202
US

IV. Provider business mailing address

5025 PLANO PARKWAY
CARROLLTON TX
75010
US

V. Phone/Fax

Practice location:
  • Phone: 877-654-7812
  • Fax: 469-365-8274
Mailing address:
  • Phone: 469-365-8245
  • Fax: 469-365-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP07549
License Number StateKY

VIII. Authorized Official

Name: MS. JOSEPH MAX EILER
Title or Position: SR. DIRECTOR PHARMACY SERVICES
Credential: RPH
Phone: 469-365-8338