Provider Demographics
NPI:1215359518
Name:CONTINUED CARE LTC PHARMACY LLC
Entity Type:Organization
Organization Name:CONTINUED CARE LTC PHARMACY LLC
Other - Org Name:CONTINUED CARE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-277-2132
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1350
Mailing Address - Country:US
Mailing Address - Phone:888-277-2132
Mailing Address - Fax:877-231-6468
Practice Address - Street 1:9320 HAZARD WAY STE B1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1227
Practice Address - Country:US
Practice Address - Phone:888-277-2132
Practice Address - Fax:877-231-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X, 3336L0003X
CA544703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215359518Medicaid
CA1215359518Medicaid