Provider Demographics
NPI:1750488797
Name:LONG TERM CARE RX
Entity Type:Organization
Organization Name:LONG TERM CARE RX
Other - Org Name:THE MEDICINE SHOPPE # 589
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-832-7605
Mailing Address - Street 1:3461 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1941
Mailing Address - Country:US
Mailing Address - Phone:314-832-7605
Mailing Address - Fax:314-832-7606
Practice Address - Street 1:3461 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1941
Practice Address - Country:US
Practice Address - Phone:314-832-7605
Practice Address - Fax:314-832-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0059733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2622062OtherNCPDP #
MO600124911Medicaid
MOBT4964614OtherDEA #
MO600124911Medicaid
MO0698620002Medicare NSC