NPIMap

Organization Active NPI

Neighborhood LTC Pharmacy Inc.

Doing business as Neighborhood LTC Pharmacy

  • Long Term Care Pharmacy
  • Phoenix, AZ
National Provider Identifier
1699425959
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
NEIGHBORHOOD LTC PHARMACY INC.
Doing business as
Neighborhood LTC Pharmacy
Practice address
690 N Cofco Center CT Ste 100
Phoenix, AZ 85008-6466
Phone
(602) 396-7330
Fax
(602) 688-8016
NPI assigned
Mar 28, 2022
Last updated
Oct 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Authorized official

Name
Marissa McMahon, PHARMDNPI 1871035964
Title
Coo
Phone
(402) 488-1184

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

690 N Cofco Center CT Ste 100
Phoenix, AZ 85008-6466

Mailing address

1265 S Cotner Blvd Ste 30
Lincoln, NE 68510-4924
Phone (402) 488-1184

Other identifiers 4

IdentifierTypeStateIssuer
158929MedicaidAZ
4286581MedicaidUT
61380849MedicaidNM
1699425959MedicaidNC

Other names 1

  • Neighborhood LTC Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231117000258 AZ DME Supplier - Pharmacy 8628290673 Practice locations: Phoenix, AZ
O20240924001765 AZ Part B Supplier - Pharmacy 8628290673 Practice locations: Phoenix, AZ

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Neighborhood LTC Pharmacy690 N Cofco Center CT, Phoenix, AZ 85008-6466(602) 396-7330 Nebulizer Drugs Accepts assignmentParticipating since Dec 21, 2020

National Provider Directory

National Provider Directory
Tax ID family
Neighborhood LTC Pharmacy10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10711 Justin Dr
Urbandale, IA 50322
Phone (515) 989-8301

2525 NW South Outer Rd
Ste D
Blue Springs, MO 64015
Phone (402) 802-4874

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1699425959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 S COTNER BLVD STE 30",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685104924",
            "telephone_number": "402-488-1184",
            "fax_number": "402-488-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 N COFCO CENTER CT STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086466",
            "telephone_number": "602-396-7330",
            "fax_number": "602-688-8016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD LTC PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-28",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "MCMAHON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "402-488-1184",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158929",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4286581",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61380849",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699425959",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neighborhood LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Neighborhood LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.