Healthcare Provider Details

I. General information

NPI: 1831743632
Provider Name (Legal Business Name): TTGI2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 WEST MAIN STREET
WISE VA
24293
US

IV. Provider business mailing address

PO BOX 1439
COEBURN VA
24230-1439
US

V. Phone/Fax

Practice location:
  • Phone: 276-321-0088
  • Fax: 276-807-7341
Mailing address:
  • Phone: 276-321-0088
  • Fax: 276-807-7341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SCOTT VILLIARD
Title or Position: PHARMACIST
Credential: RPH
Phone: 276-321-0088