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General NPI Number Information
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NPI Number | 1225313216
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Entity Type | Organization
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Legal Business Name | L T C PHARMACY, LLC
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 06/27/2014
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Provider Practice Location Address
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Address Line | 2233 TRACY RD STE B
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City | NORTHWOOD
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State | OH
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Zip | 43619-1302
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Country | US
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Telephone | 419-214-3198
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Fax | 616-554-9581
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Provider Business Mailing Address
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Address Line | 2233 TRACY RD STE B
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City | NORTHWOOD
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State | OH
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Zip | 43619-1302
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Country | US
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Telephone | 419-214-3198
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Fax | 616-554-9581
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER MICHAEL SCHOEN
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Credential |
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Telephone | 616-214-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 022158900
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License Number State | OH
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