Healthcare Provider Details

I. General information

NPI: 1285656215
Provider Name (Legal Business Name): LONG TERM CARE RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E MULBERRY ST STE B
ANGLETON TX
77515-3804
US

IV. Provider business mailing address

2301 E MULBERRY ST SUITE B
ANGLETON TX
77515-3804
US

V. Phone/Fax

Practice location:
  • Phone: 979-849-3001
  • Fax: 979-848-0900
Mailing address:
  • Phone: 979-849-3001
  • Fax: 979-848-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number24288
License Number StateTX

VIII. Authorized Official

Name: W DAVID SPENCE
Title or Position: PRESIDENT
Credential:
Phone: 979-849-3001