Broadway LTC Pharmacy, Inc.

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHY44334 Issued in CA

Legal business name

BROADWAY LTC PHARMACY, INC.

Practice address

3330 Broadway
Sacramento, CA 95817-2840

Phone

(916) 452-8022

Fax

(916) 452-6326

NPI assigned

Sep 8, 2005

Organization subpart

No

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

Authorized official

Name

David Carroll, PHARMD

Title

Ceo

Phone

(916) 364-2418

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821082504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 HARLIN DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958269716",
            "telephone_number": "916-364-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 BROADWAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172840",
            "telephone_number": "916-452-8022",
            "fax_number": "916-452-6326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY LTC PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-364-2418",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "PHY44334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA443340",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelley Elizabeth Britts
• Justin M Broadbent, NP
• Lucas Broadhurst, CPO
• Robert B. Broadhurst, MD
• Michelle Alce Broadnax
• Broadway Medical Service & Supply, Inc
• Kirk Loyd Broadway
• Tiffany Broce, APRN
• Cameron Lyle Brock, MD
• Kyla Nellie Brock

• Pharmacist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.