Provider Demographics
NPI:1760074579
Name:SELECT LTC PHARMACY CORPORATION
Entity Type:Organization
Organization Name:SELECT LTC PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHULPAEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-341-3455
Mailing Address - Street 1:11203 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6112
Mailing Address - Country:US
Mailing Address - Phone:310-341-3455
Mailing Address - Fax:310-341-3454
Practice Address - Street 1:11203 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6112
Practice Address - Country:US
Practice Address - Phone:310-341-3455
Practice Address - Fax:310-341-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy