# MEDICINE CENTRE LTC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013928654
- **Authorized official:** WILLIAM CARLONE RPH (OWNER)
- **Authorized official phone:** (860) 983-8066

## Contact information

- **Practice address:** 41 SULLIVAN ST, SPRINGFIELD, MA 01104
- **Practice address phone:** (413) 739-6100
- **Practice address fax:** (413) 739-6106
- **Mailing address:** 41 SULLIVAN ST, SPRINGFIELD, MA 01104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 3455 | MA | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 09/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2241468 | OTHER ID NUMBER | — |