Healthcare Provider Details

I. General information

NPI: 1720099369
Provider Name (Legal Business Name): TLGRX CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8579 S EASTERN AVE STE B
LAS VEGAS NV
89123-2887
US

IV. Provider business mailing address

8579 S EASTERN AVE STE B
LAS VEGAS NV
89123-2887
US

V. Phone/Fax

Practice location:
  • Phone: 702-792-3777
  • Fax: 702-792-1171
Mailing address:
  • Phone: 702-792-3777
  • Fax: 702-792-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHC02144
License Number StateNV

VIII. Authorized Official

Name: MATTHEW LASARSO
Title or Position: PIC
Credential:
Phone: 702-792-3777