Provider Demographics
NPI:1215338058
Name:TRUST CONCIERGE PHARMACEUTICALS LLC
Entity type:Organization
Organization Name:TRUST CONCIERGE PHARMACEUTICALS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-222-5691
Mailing Address - Street 1:4999 CAROLINA FOREST BLVD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3587
Mailing Address - Country:US
Mailing Address - Phone:843-236-7733
Mailing Address - Fax:843-236-5805
Practice Address - Street 1:4999 CAROLINA FOREST BLVD STE 13
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3587
Practice Address - Country:US
Practice Address - Phone:843-236-7733
Practice Address - Fax:843-236-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X, 3336C0004X, 3336L0003X, 3336M0002X, 3336S0011X
SC155073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147859OtherPK
SC7351890001Medicare NSC