Healthcare Provider Details

I. General information

NPI: 1396049706
Provider Name (Legal Business Name): LTC RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 E SPRUCE ST STE 102
CHIPPEWA FALLS WI
54729-2579
US

IV. Provider business mailing address

13 E SPRUCE ST STE 102
CHIPPEWA FALLS WI
54729-2579
US

V. Phone/Fax

Practice location:
  • Phone: 715-861-4422
  • Fax: 715-861-5141
Mailing address:
  • Phone: 715-861-4422
  • Fax: 715-861-5141

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 TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number9055-042
License Number StateWI

VIII. Authorized Official

Name: PAUL WINGER
Title or Position: OWNER
Credential:
Phone: 715-723-9192