Provider Demographics
NPI:1437324522
Name:SKILLED CARE PHARMACY,LLC
Entity Type:Organization
Organization Name:SKILLED CARE PHARMACY,LLC
Other - Org Name:SKILLED CARE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GALLUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-459-7455
Mailing Address - Street 1:6175 HI TEK COURT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-459-7455
Mailing Address - Fax:800-786-9419
Practice Address - Street 1:6175 HI TEK CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2603
Practice Address - Country:US
Practice Address - Phone:513-459-7455
Practice Address - Fax:800-786-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022280050332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0705973Medicaid
OH6892520001Medicare NSC