Healthcare Provider Details

I. General information

NPI: 1447632096
Provider Name (Legal Business Name): LTCARERX CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15430 FRANCES LN NW
MILTONA MN
56354-8320
US

IV. Provider business mailing address

15430 FRANCES LN NW
MILTONA MN
56354-8320
US

V. Phone/Fax

Practice location:
  • Phone: 612-618-1389
  • Fax:
Mailing address:
  • Phone: 612-618-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number116251
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number116251
License Number StateMN

VIII. Authorized Official

Name: DEBRA DEANN LEYES
Title or Position: PRESIDENT OWNER PHARMACIST
Credential: R.PH. C.G.P.
Phone: 612-618-1389