Provider Demographics
NPI:1609273630
Name:LTC PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:LTC PHARMACY SERVICES LLC
Other - Org Name:LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-473-5982
Mailing Address - Street 1:3915 ADKISSON DR. NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311
Mailing Address - Country:US
Mailing Address - Phone:423-473-5982
Mailing Address - Fax:
Practice Address - Street 1:3915 ADKISSON DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2821
Practice Address - Country:US
Practice Address - Phone:423-473-5982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54953336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148840OtherPK