Provider Demographics
NPI:1003369315
Name:CHRONICARE LTC RX LLC
Entity Type:Organization
Organization Name:CHRONICARE LTC RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:ARONOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-275-8900
Mailing Address - Street 1:68-54 AUSTIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-590-5999
Mailing Address - Fax:718-590-5966
Practice Address - Street 1:6854 AUSTIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4242
Practice Address - Country:US
Practice Address - Phone:718-590-5999
Practice Address - Fax:718-590-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0346063336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163635OtherPK
NY04701162Medicaid