Provider Demographics
NPI:1306138334
Name:IHS-LTC,LLC
Entity type:Organization
Organization Name:IHS-LTC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-374-0899
Mailing Address - Street 1:104 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2912
Mailing Address - Country:US
Mailing Address - Phone:937-372-5480
Mailing Address - Fax:937-372-5742
Practice Address - Street 1:104 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2912
Practice Address - Country:US
Practice Address - Phone:937-372-5480
Practice Address - Fax:937-372-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0221120503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy