Provider Demographics
NPI:1629613005
Name:LOTUS LTC PHARMACY LLC
Entity Type:Organization
Organization Name:LOTUS LTC PHARMACY LLC
Other - Org Name:LOTUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LYTWYN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:612-425-9145
Mailing Address - Street 1:PO BOX 27559
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-0559
Mailing Address - Country:US
Mailing Address - Phone:612-425-9145
Mailing Address - Fax:
Practice Address - Street 1:9850 51ST AVE N STE 102
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-3271
Practice Address - Country:US
Practice Address - Phone:612-415-9145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy