MEDICARE: B2TF LTC PHARMACY 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	20647	TX

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

General Provider Information

NPI Number	:	1821000852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B2TF LTC PHARMACY LLC

Provider Business Mailing Address
First Line	:	403 NORTH KAUFMAN STREET
Second Line	:
City	:	LINDEN
State	:	TX
Zip	:	75563
Country	:	US
Telephone Number	:	903-756-8741
Fax Number	:	903-756-8741

Provider Business Practice Location Address
First Line	:	403 NORTH KAUFMAN STREET
Second Line	:
City	:	LINDEN
State	:	TX
Zip	:	75563-5234
Country	:	US
Telephone Number	:	903-756-8741
Fax Number	:	903-756-8741

Authorized Official
Title or Position	:	VP/PHARMACIST
Name	:	MR. HOWARD A PAVIA
Credential	:	RPH
Telephone Number	:	903-756-8741

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/22/2020

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