Organization
SELECT LTC PHARMACY CORPORATION
Active
Other names
SELECT LTC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ELLINA CHULPAEFF (SECRETARY/CFO)
(951) 530-1188
Entity
Organization
Contact information
Practice address
833 MARLBOROUGH AVE STE 200, RIVERSIDE, CA 92507-2133
(951) 530-1188
(951) 530-1118
Mailing address
833 MARLBOROUGH AVE STE 200, RIVERSIDE, CA 92507-2133
(951) 530-1188
(951) 530-1118
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY59364
BOARD OF PHARMACY
CA
Enumeration date
02/02/2024
Last updated
02/02/2024
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