Active NPI
LTC Pharmacy, LLC
- Pharmacy
- Kentwood, MI
National Provider Identifier
1538405774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 5301009544
- Legal business name
- LTC PHARMACY, LLC
- Practice address
- 4477 E Paris Ave SE
Kentwood, MI 49512-5312 - Phone
- (616) 214-8011
- Fax
- (616) 554-9581
- NPI assigned
- Dec 17, 2012
- Organization subpart
- Yes
- Parent organization
- PRESCRIPTION SUPPLY INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Christopher Schoen
- Title
- Vice President
- Phone
- (616) 214-8011
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 5301009544 | MI | Primary |
Addresses
Primary practice location
4477 E Paris Ave SE
Kentwood, MI 49512-5312
Mailing address
4477 E Paris Ave SE
Kentwood, MI 49512-5312
Phone (616) 214-8011
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588963706 | Medicaid | MI |
National Provider Directory
National Provider Directory- Tax ID family
- L T C Pharmacy LLC
- Part of
- L T C Pharmacy LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Grand Rapids, MI
- NPI 1588963706
Locations
4477 East Paris Ave SE
Kentwood, MI 49512
Phone (616) 214-8011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355702400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1392595200000",
"number": "1538405774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4477 E PARIS AVE SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495125312",
"telephone_number": "616-214-8011",
"fax_number": "616-554-9581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4477 E PARIS AVE SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495125312",
"telephone_number": "616-214-8011",
"fax_number": "616-554-9581"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LTC PHARMACY, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PRESCRIPTION SUPPLY INC.",
"enumeration_date": "2012-12-17",
"last_updated": "2014-02-17",
"status": "A",
"authorized_official_last_name": "SCHOEN",
"authorized_official_first_name": "CHRISTOPHER",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "616-214-8011",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MI",
"license": "5301009544",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1588963706",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kentwood, MI
- Linden Pharmacy LLC (Advanced Specialty Rx West)
- Live Laugh Love Home Care LLC
- Live Well, PLLC
- Lonias World Care Center
- Callan Loughin, BEHAVIOR TECHNICIAN
- Katherine H Luczkowski
- Brooke Anna Lundie
- Kaitlyn Elizabeth Goss Luth, BCBA
- Luxottica Retail North America Inc (Pearle Vision #C6855)
- Beth Macauley, PH.D., CCC-SLP, HPCS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.