MEDICARE: TPS RX

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
1	333600000X	Pharmacy	11354	NC

General Provider Information

NPI Number	:	1245582089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TPS RX

Provider Business Mailing Address
First Line	:	2250 SHIPYARD BLVD STE 11
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-442-2056
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 SHIPYARD BLVD STE 11
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-442-2056
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BRION W BOWMAN
Credential	:
Telephone Number	:	205-608-4995

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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Directions to “TPS RX ” Practice Location

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