Provider Demographics
NPI:1134218787
Name:LONG TERM RX
Entity type:Organization
Organization Name:LONG TERM RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MGR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-529-1338
Mailing Address - Street 1:540 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4922
Practice Address - Country:US
Practice Address - Phone:765-529-1338
Practice Address - Fax:765-521-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004040A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1527970OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0521760001Medicare ID - Type Unspecified