Provider Demographics
NPI:1114271855
Name:LONG TERM PHARMACEUTICAL SOLUTIONS INC
Entity Type:Organization
Organization Name:LONG TERM PHARMACEUTICAL SOLUTIONS INC
Other - Org Name:LIFECARE PHARMACY II LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-231-1141
Mailing Address - Street 1:910 E LINCOLN AVE
Mailing Address - Street 2:STE C
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1393
Mailing Address - Country:US
Mailing Address - Phone:616-200-8300
Mailing Address - Fax:616-200-8383
Practice Address - Street 1:910 E LINCOLN AVE STE C
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1393
Practice Address - Country:US
Practice Address - Phone:616-200-8300
Practice Address - Fax:616-200-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010099483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114271855Medicaid
2377340OtherNCPDP PROVIDER IDENTIFICATION NUMBER