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General NPI Number Information
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NPI Number | 1801410642
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Entity Type | Organization
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Legal Business Name | TPS COMPOUNDING AND LONG TERM CARE PHARMACY LLC
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Dates
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Enumeration Date | 06/06/2020
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 4097 IRONBOUND RD STE B
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2676
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Country | US
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Telephone | 757-206-1630
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Fax | 757-612-4434
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Provider Business Mailing Address
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Address Line | 5223 MONTICELLO AVE STE C
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-8236
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Country | US
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Telephone | 757-603-1245
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HENRY KYLE RANGER
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Credential |
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Telephone | 757-206-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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