Ttgi Corp
Organization Active NPI Community/Retail Pharmacy · Coeburn, VA
NPI 1447736152 · NPPES record last updated Jan 26, 2026
Key facts
- NPI
- 1447736152
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- TTGI CORP
- Practice address
- 201 Laurel Ave
Coeburn, VA 24230 - Phone
- (276) 807-7106
- Fax
- (276) 807-7341
- NPI assigned
- Jul 16, 2018
- Organization subpart
- No
Authorized official
- Name
- Mr. Matthew Scott Villiard, RPH
- Title
- Pharmacist
- Phone
- (276) 337-7131
Subparts reporting this organization as parent 1
Practitioners 2
-
Nicholas Dwayne Jackson, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2188856 | Spartan Drug | Certificate of waiver | Jul 22, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190205000572 | VA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8820336530 | Practice locations: Coeburn, VA |
| O20210330000058 | VA | Part B Supplier - Independent Clinical Laboratory | 8820336530 | Practice locations: Coeburn, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
201 Laurel Ave
Coeburn, VA 24230
Mailing address
9609 Emory Ave
Wise, VA 24293-4413
Phone (276) 337-7131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447736152 | Medicaid | VA |
Other names
- Spartan Drug
Other providers in Coeburn, VA
- Joseph F Smiddy
- Scarlett Ann Solomon
- Southwest Ambulance Service LLC
- St Charles Health Council Inc
- Leandra Stanley
- Teresa Tyson
- Matthew Scott Villiard
- Walgreen Co
- Adrienne Angelopoulos Ward
- Caleb Williams
All providers in Coeburn, VA · Community/Retail Pharmacy in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.