Provider Demographics
NPI:1114384559
Name:TRUCARE LTC, LLC
Entity Type:Organization
Organization Name:TRUCARE LTC, LLC
Other - Org Name:TRUCARE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-998-6772
Mailing Address - Street 1:6140 28TH ST SE STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6938
Mailing Address - Country:US
Mailing Address - Phone:616-965-7480
Mailing Address - Fax:616-974-8205
Practice Address - Street 1:6140 28TH ST SE STE 105
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6938
Practice Address - Country:US
Practice Address - Phone:616-965-7480
Practice Address - Fax:616-974-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MI53010108993336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155947OtherPK