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NPI Code Detail

MEDICARE: TARRYTOWN EXPOCARE IL LLC

MEDICARE: TARRYTOWN EXPOCARE IL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1154975340
Entity Type Code : Organization
Provider Name (Legal Business Name) : TARRYTOWN EXPOCARE IL LLC
Provider Business Mailing Address
First Line : 8500 SHOAL CREEK BLVD BLDG 1
Second Line :
City : AUSTIN
State : TX
Zip : 78757-6888
Country : US
Telephone Number : 855-887-9397
Fax Number : 855-617-7313
Provider Business Practice Location Address
First Line : 8145 RIVER DR STE 106
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2645
Country : US
Telephone Number : 855-887-9397
Fax Number : 855-617-7313
Authorized Official
Title or Position : CEO
Name : MARK LASHLEY
Credential :
Telephone Number : 512-617-7312
Provider Enumeration Date : 07/26/2019
Last Update Date : 06/01/2023

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Directions to “TARRYTOWN EXPOCARE IL LLC ” Practice Location

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