Provider Demographics
NPI:1740201706
Name:PLTCP LLC
Entity Type:Organization
Organization Name:PLTCP LLC
Other - Org Name:PALMETTO LONG TERM CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-397-8904
Mailing Address - Street 1:4900 PERRY HWY
Mailing Address - Street 2:BUILDING 2, 3RD FL
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-2220
Mailing Address - Country:US
Mailing Address - Phone:412-931-3131
Mailing Address - Fax:412-931-2361
Practice Address - Street 1:317 ZIMALCREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6833
Practice Address - Country:US
Practice Address - Phone:803-731-0203
Practice Address - Fax:866-935-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC140613336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4225454OtherNCPDP PROVIDER IDENTIFICATION NUMBER