Provider Demographics
NPI:1669589651
Name:LTC PHARMACY SERVICES INC
Entity type:Organization
Organization Name:LTC PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:MBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-489-5770
Mailing Address - Street 1:13708 BOLD VENTURE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737
Mailing Address - Country:US
Mailing Address - Phone:410-489-5770
Mailing Address - Fax:410-489-5771
Practice Address - Street 1:13708 BOLD VENTURE DRIVE
Practice Address - Street 2:
Practice Address - City:GLENELG
Practice Address - State:MD
Practice Address - Zip Code:21737
Practice Address - Country:US
Practice Address - Phone:410-489-5770
Practice Address - Fax:410-489-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0251333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW0251OtherST LC
BL8787088OtherDEA