Provider Demographics
NPI:1225313216
Name:L T C PHARMACY, LLC
Entity Type:Organization
Organization Name:L T C PHARMACY, LLC
Other - Org Name:L T C PHARMACY, OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
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:419-214-3198
Mailing Address - Fax:616-554-9581
Practice Address - Street 1:2233 TRACY RD STE B
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1302
Practice Address - Country:US
Practice Address - Phone:419-214-3198
Practice Address - Fax:616-554-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0221589003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063624Medicaid