NPIMap

Organization Active NPI

Cppltc LLC

  • Long Term Care Pharmacy
  • West Lafayette, IN
National Provider Identifier
1407235013
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
CPPLTC LLC
Practice address
482 W Navajo St Ste B
West Lafayette, IN 47906-1940
Phone
(765) 607-4103
Fax
(765) 607-4109
NPI assigned
May 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Matthew Hutera
Title
Owner
Phone
(654) 214-3762

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

482 W Navajo St Ste B
West Lafayette, IN 47906-1940

Mailing address

482 W Navajo St Ste B
West Lafayette, IN 47906-1940
Phone (765) 607-4103

Other names 1

  • Custom Plus Long Term Care LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

482 W Navajo St
#B
West Lafayette, IN 47906
Phone (765) 607-4103

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1407235013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 W NAVAJO ST STE B",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061940",
            "telephone_number": "765-607-4103",
            "fax_number": "765-607-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 W NAVAJO ST STE B",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061940",
            "telephone_number": "765-607-4103",
            "fax_number": "765-607-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPPLTC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-28",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "HUTERA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "654-214-3762"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Plus Long Term Care LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in West Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.