Provider Demographics
NPI:1063031698
Name:LTC LEONARD LLC
Entity Type:Organization
Organization Name:LTC LEONARD LLC
Other - Org Name:LTC WELCOME SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-214-8011
Mailing Address - Street 1:2233 TRACY RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-1302
Mailing Address - Country:US
Mailing Address - Phone:616-214-8011
Mailing Address - Fax:616-554-9581
Practice Address - Street 1:303 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4113
Practice Address - Country:US
Practice Address - Phone:419-654-1973
Practice Address - Fax:616-554-9581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESCRIPTION SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy