Healthcare Provider Details

I. General information

NPI: 1457633687
Provider Name (Legal Business Name): TCCT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 B ROGER COMBS BLVD
HINDMAN KY
41822
US

IV. Provider business mailing address

PO BOX 973
HINDMAN KY
41822-0973
US

V. Phone/Fax

Practice location:
  • Phone: 606-785-5700
  • Fax: 606-785-4004
Mailing address:
  • Phone: 606-785-5607
  • Fax: 606-785-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07462
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TODD HALL
Title or Position: MEMBER
Credential: PHARMD.
Phone: 606-785-5700