Provider Demographics
NPI:1689371759
Name:NEIGHBORHOOD LTC PHARMACY INC
Entity Type:Organization
Organization Name:NEIGHBORHOOD LTC PHARMACY INC
Other - Org Name:NEIGHBORHOOD LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-488-1184
Mailing Address - Street 1:1265 S COTNER BLVD STE 30
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4924
Mailing Address - Country:US
Mailing Address - Phone:402-488-1184
Mailing Address - Fax:
Practice Address - Street 1:3705 W MEMORIAL RD STE 506
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1506
Practice Address - Country:US
Practice Address - Phone:405-479-8098
Practice Address - Fax:402-479-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201092580BMedicaid