Provider Demographics
NPI:1548321615
Name:LONG TERM CARE RX LLC
Entity type:Organization
Organization Name:LONG TERM CARE RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-858-6175
Mailing Address - Street 1:149 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2142
Mailing Address - Country:US
Mailing Address - Phone:888-858-6175
Mailing Address - Fax:888-858-6176
Practice Address - Street 1:149 3RD AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2142
Practice Address - Country:US
Practice Address - Phone:888-858-6175
Practice Address - Fax:888-858-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005987003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3106057OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ8528403Medicaid
4256290001Medicare NSC