Healthcare Provider Details

I. General information

NPI: 1851842827
Provider Name (Legal Business Name): THERACOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9717 KEY WEST AVE
ROCKVILLE MD
20850-3982
US

IV. Provider business mailing address

3101 GAYLORD PKWY
FRISCO TX
75034-8655
US

V. Phone/Fax

Practice location:
  • Phone: 888-843-7226
  • Fax:
Mailing address:
  • Phone: 469-365-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPO5597
License Number StateMD

VIII. Authorized Official

Name: TRACY FOSTER
Title or Position: PRESIDENT LASH CONSULTING GROUP
Credential:
Phone: 704-357-3071