Provider Demographics
NPI:1922710631
Name:LTC PHARMCO LLC
Entity Type:Organization
Organization Name:LTC PHARMCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-588-8700
Mailing Address - Street 1:703 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6814
Mailing Address - Country:US
Mailing Address - Phone:563-588-8700
Mailing Address - Fax:563-588-8750
Practice Address - Street 1:1355 SHERMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1208
Practice Address - Country:US
Practice Address - Phone:319-249-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy