Provider Demographics
NPI:1841234689
Name:LCPS ACQUISITION, LLC
Entity Type:Organization
Organization Name:LCPS ACQUISITION, LLC
Other - Org Name:OMNICARE OF PRESCOTT #48206
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-765-1500
Mailing Address - Fax:
Practice Address - Street 1:930 12TH PL
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1436
Practice Address - Country:US
Practice Address - Phone:928-776-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2024-02-29
Deactivation Date:2024-02-20
Deactivation Code:
Reactivation Date:2024-02-29
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 332BP3500X
AZ39913336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841234689Medicaid
MT1841234689Medicaid
AZ0319372OtherNCPDP
NV184234689Medicaid
NM32620373Medicaid
NE10026075800Medicaid
AZ852766Medicaid
NE10026075800Medicaid