Provider Demographics
NPI:1922070929
Name:LTC LEONARD LLC
Entity Type:Organization
Organization Name:LTC LEONARD LLC
Other - Org Name:LTC WELCOME PHARMACY MICHIGAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-654-1973
Mailing Address - Street 1:2233 TRACY RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-1302
Mailing Address - Country:US
Mailing Address - Phone:517-764-0400
Mailing Address - Fax:517-764-0475
Practice Address - Street 1:4646 PAGE AVENUE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CENTER
Practice Address - State:MI
Practice Address - Zip Code:49254-1042
Practice Address - Country:US
Practice Address - Phone:517-764-0400
Practice Address - Fax:517-764-0475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESCRIPTION SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301000646332B00000X, 333600000X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2307254OtherNCPDP/NABP
MI872503134Medicaid
MI540C805637OtherBLUE CROSS BLUE SHIELD
MI540C805637OtherBLUE CROSS BLUE SHIELD
MI2307254OtherNCPDP/NABP
MI0469040001Medicare NSC