Provider Demographics
NPI:1063410504
Name:SKILLED CARE PHARMACY LLC
Entity type:Organization
Organization Name:SKILLED CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GALLUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-459-7455
Mailing Address - Street 1:6175 HI TEK CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2603
Mailing Address - Country:US
Mailing Address - Phone:513-459-7455
Mailing Address - Fax:513-459-7969
Practice Address - Street 1:6175 HI TEK COURT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-459-7455
Practice Address - Fax:513-459-7969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKILLED CARE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0222800503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90272303Medicaid
KY7100178190Medicaid
OH0465205Medicaid
3638155OtherNABP
3638155OtherNABP
OH1437324522Medicare NSC
OH6892520001Medicare NSC