Provider Demographics
NPI:1134363872
Name:LTC SCRIPTSRX LLC
Entity type:Organization
Organization Name:LTC SCRIPTSRX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARAIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-783-7200
Mailing Address - Street 1:1002 N PARKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3613
Mailing Address - Country:US
Mailing Address - Phone:337-783-7200
Mailing Address - Fax:337-785-3116
Practice Address - Street 1:572 MADDOX DR
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-4000
Practice Address - Country:US
Practice Address - Phone:706-635-7931
Practice Address - Fax:706-635-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy