Provider Demographics
NPI:1871125047
Name:TABULA RASA HEALTHCARE GROUP, INC.
Entity type:Organization
Organization Name:TABULA RASA HEALTHCARE GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP REGULATORY AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:856-840-4821
Mailing Address - Street 1:228 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4600
Mailing Address - Country:US
Mailing Address - Phone:856-840-4821
Mailing Address - Fax:
Practice Address - Street 1:225 METRO CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1783
Practice Address - Country:US
Practice Address - Phone:401-593-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABULA RASA HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-06
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy