MEDICARE: TD HEALTHCARE 2 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	27815	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891219564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TD HEALTHCARE 2 LLC

Provider Business Mailing Address
First Line	:	10113 CHICAGO AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-8254
Country	:	US
Telephone Number	:	813-244-9882
Fax Number	:	806-783-0883

Provider Business Practice Location Address
First Line	:	3436 34TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79410-2830
Country	:	US
Telephone Number	:	806-799-3636
Fax Number	:	806-795-4622

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	DAVID L FUNG
Credential	:	RPH
Telephone Number	:	813-244-9882

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/03/2017

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Directions to “TD HEALTHCARE 2 LLC ” Practice Location

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