MEDICARE: TARRYTOWN EXPOCARE, 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
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1437988300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRYTOWN EXPOCARE, 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	:	855-617-7312
Fax Number	:	512-617-7313

Provider Business Practice Location Address
First Line	:	5807 BRECKENRIDGE PKWY STE A&B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4258
Country	:	US
Telephone Number	:	855-617-7312
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARK LASHLEY
Credential	:
Telephone Number	:	855-617-7312

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	05/28/2026

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