Healthcare Provider Details

I. General information

NPI: 1700660263
Provider Name (Legal Business Name): LTC PHARMACY VENTURES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E MAIN ST STE 104
EL CAJON CA
92020-3993
US

IV. Provider business mailing address

161 E MAIN ST STE 104
EL CAJON CA
92020-3993
US

V. Phone/Fax

Practice location:
  • Phone: 858-878-4150
  • Fax: 858-878-4152
Mailing address:
  • Phone: 858-878-4150
  • Fax: 858-878-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YEFIM ISKHAKOV
Title or Position: PRESIDENT/CEO
Credential:
Phone: 858-878-4150