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General NPI Number Information
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NPI Number | 1689047458
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Entity Type | Organization
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Legal Business Name | TGSC VENTURES, LLC
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 312 W 8TH ST
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City | COZAD
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State | NE
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Zip | 69130-1772
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Country | US
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Telephone | 308-784-3500
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Fax | 308-784-3502
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Provider Business Mailing Address
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Address Line | 312 W 8TH ST
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City | COZAD
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State | NE
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Zip | 69130-1772
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Country | US
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Telephone | 308-784-3500
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Fax | 308-784-3502
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Authorized Official
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Title or Position | CO-OWNER, PIC, AO
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Name | TYLER STURGEON
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Credential | RPH
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Telephone | 308-529-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3117
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License Number State | NE
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