Provider Demographics
NPI:1932565108
Name:TOLEDO LTC LLC
Entity Type:Organization
Organization Name:TOLEDO LTC LLC
Other - Org Name:TOLEDO FAMILY PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-414-0249
Mailing Address - Street 1:529 DORR ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8021
Mailing Address - Country:US
Mailing Address - Phone:419-386-0534
Mailing Address - Fax:419-476-0726
Practice Address - Street 1:529 DORR ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-8021
Practice Address - Country:US
Practice Address - Phone:419-386-0534
Practice Address - Fax:419-476-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OH0225586003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163528Medicaid
2157350OtherPK