Provider Demographics
NPI:1164285110
Name:SELECT LTC PHARMACY CORPORATION
Entity Type:Organization
Organization Name:SELECT LTC PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHULPAEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-530-1188
Mailing Address - Street 1:833 MARLBOROUGH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2133
Mailing Address - Country:US
Mailing Address - Phone:951-530-1188
Mailing Address - Fax:951-530-1118
Practice Address - Street 1:833 MARLBOROUGH AVE STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2133
Practice Address - Country:US
Practice Address - Phone:951-530-1188
Practice Address - Fax:951-530-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59364OtherBOARD OF PHARMACY