Provider Demographics
NPI:1700660263
Name:LTC PHARMACY VENTURES CORP
Entity type:Organization
Organization Name:LTC PHARMACY VENTURES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:YEFIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-878-4150
Mailing Address - Street 1:161 E MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3993
Mailing Address - Country:US
Mailing Address - Phone:858-878-4150
Mailing Address - Fax:858-878-4152
Practice Address - Street 1:161 E MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3993
Practice Address - Country:US
Practice Address - Phone:858-878-4150
Practice Address - Fax:858-878-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY60529OtherBOARD OF PHARMACY