Provider Demographics
NPI:1396255949
Name:LEVEL CARE PHARMACY I LLC
Entity type:Organization
Organization Name:LEVEL CARE PHARMACY I LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-PHARMACY CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:MAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-370-9915
Mailing Address - Street 1:212 CARPENTERS UNION WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4231
Mailing Address - Country:US
Mailing Address - Phone:847-370-9915
Mailing Address - Fax:
Practice Address - Street 1:212 CARPENTERS UNION WAY STE 500
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-905-4435
Practice Address - Fax:702-920-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180074123336S0011X
COOSP.00070643336S0011X
NVPH037953336S0011X
IL054.0206573336S0011X
MDP076923336S0011X
DEA9-00021163336S0011X
CTPCN.00034193336S0011X
FLPH311523336S0011X
NDPHAR14663336S0011X
MN2655203336S0011X
IN64002460A3336S0011X
KS22-1047633336S0011X
GAPHNR0013913336S0011X
NJ28RO001682003336S0011X
AK1295163336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171909OtherPK