Healthcare Provider Details

I. General information

NPI: 1285030379
Provider Name (Legal Business Name): LTC PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 ADKISSON DR NW
CLEVELAND TN
37312-2821
US

IV. Provider business mailing address

3915 ADKISSON DR NW
CLEVELAND TN
37312-2821
US

V. Phone/Fax

Practice location:
  • Phone: 423-473-5982
  • Fax: 844-778-0700
Mailing address:
  • Phone: 423-473-5982
  • Fax: 844-778-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5495
License Number StateTN

VIII. Authorized Official

Name: CRAIG SCHEEL
Title or Position: PRESIDENT
Credential:
Phone: 423-473-5982