MEDICARE: HORIZON PHARMACY LTC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2174038	OTHER		PK

General Provider Information

NPI Number	:	1093229361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON PHARMACY LTC, LLC

Provider Business Mailing Address
First Line	:	PO BOX 87
Second Line	:
City	:	RICHLAND
State	:	MI
Zip	:	49083-0087
Country	:	US
Telephone Number	:	616-913-2007
Fax Number	:	616-913-3060

Provider Business Practice Location Address
First Line	:	4150 KALAMAZOO AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-3605
Country	:	US
Telephone Number	:	616-591-9595
Fax Number	:	616-208-9596

Authorized Official
Title or Position	:	OWNER
Name	:	ERIK NELSON
Credential	:
Telephone Number	:	616-591-9595

Provider Enumeration Date	:	11/25/2017
Last Update Date	:	11/19/2020

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