Provider Demographics
NPI:1346629615
Name:JOHN S LTC PHARMACY INC.
Entity Type:Organization
Organization Name:JOHN S LTC PHARMACY INC.
Other - Org Name:JOHN S LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CIRAULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-201-7801
Mailing Address - Street 1:48887 HAYES RD STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4405
Mailing Address - Country:US
Mailing Address - Phone:586-279-3333
Mailing Address - Fax:586-279-1209
Practice Address - Street 1:48887 HAYES RD STE B
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4405
Practice Address - Country:US
Practice Address - Phone:586-279-3333
Practice Address - Fax:586-279-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336S0011X
MI53010107823336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346629615Medicaid
2156097OtherPK