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General NPI Number Information
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NPI Number | 1013069368
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Entity Type | Organization
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Legal Business Name | TCP1, LLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 12266 DEPAUL DRIVE SUITE 105
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-344-7567
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Fax | 314-344-7179
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Provider Business Mailing Address
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Address Line | 727 N NEW BALLAS RD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6715
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Country | US
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Telephone | 314-567-7994
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Fax | 314-567-0323
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Authorized Official
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Title or Position | DIR OF PHRM
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Name | PHIL WORRELL
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Credential | RPH
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Telephone | 314-567-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2005000826
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License Number State | MO
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