Provider Demographics
NPI:1760408637
Name:NATIONAL LTC PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:NATIONAL LTC PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-331-2661
Mailing Address - Street 1:6891 A ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4184
Mailing Address - Country:US
Mailing Address - Phone:402-489-8676
Mailing Address - Fax:402-489-0258
Practice Address - Street 1:6891 A ST STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4184
Practice Address - Country:US
Practice Address - Phone:402-489-8676
Practice Address - Fax:402-489-0258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FSQ PHARMACY HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE150OtherPHARMACY LICENSE
5346200001Medicare NSC