Healthcare Provider Details

I. General information

NPI: 1912524141
Provider Name (Legal Business Name): TPS COMPOUNDING AND LONG TERM CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4097 IRONBOUND RD STE B
WILLIAMSBURG VA
23188-2676
US

IV. Provider business mailing address

5223 MONTICELLO AVE STE C
WILLIAMSBURG VA
23188-8236
US

V. Phone/Fax

Practice location:
  • Phone: 757-206-1630
  • Fax: 757-612-4434
Mailing address:
  • Phone: 757-206-1630
  • Fax: 757-612-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: HENRY RANGER
Title or Position: OWNER
Credential:
Phone: 757-206-1630