Healthcare Provider Details

I. General information

NPI: 1699425959
Provider Name (Legal Business Name): NEIGHBORHOOD LTC PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 N COFCO CENTER CT STE 100
PHOENIX AZ
85008-6466
US

IV. Provider business mailing address

1265 S COTNER BLVD STE 30
LINCOLN NE
68510-4924
US

V. Phone/Fax

Practice location:
  • Phone: 602-396-7330
  • Fax: 602-688-8016
Mailing address:
  • Phone: 402-488-1184
  • Fax: 402-488-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARISSA MCMAHON
Title or Position: COO
Credential: PHARMD
Phone: 402-488-1184