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General NPI Number Information
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NPI Number | 1215359518
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Entity Type | Organization
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Legal Business Name | CONTINUED CARE LTC PHARMACY LLC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 9320 HAZARD WAY STE B1
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City | SAN DIEGO
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State | CA
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Zip | 92123-1227
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Country | US
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Telephone | 888-277-2132
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Fax | 877-231-6468
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Provider Business Mailing Address
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Address Line | PO BOX 1350
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City | RIVERTON
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State | UT
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Zip | 84065-1350
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Country | US
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Telephone | 888-277-2132
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Fax | 877-231-6468
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | BRANDON HAGEN
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Credential |
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Telephone | 888-277-2132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 54470
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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