Provider Demographics
NPI:1285656215
Name:LONG TERM CARE RX
Entity Type:Organization
Organization Name:LONG TERM CARE RX
Other - Org Name:LTC RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:W DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-849-3001
Mailing Address - Street 1:2301 E MULBERRY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3804
Mailing Address - Country:US
Mailing Address - Phone:979-849-3001
Mailing Address - Fax:979-848-0900
Practice Address - Street 1:2301 E MULBERRY ST STE B
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3804
Practice Address - Country:US
Practice Address - Phone:979-849-3001
Practice Address - Fax:979-848-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX242883336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4539803OtherNCPDP PROVIDER IDENTIFICATION NUMBER