Organization
LTC DISPENSARY LLC
Active
Other names
LTC DISPENSARY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
HERMAN CROTWELL RPH (CHIEF PHARMACIST OWNER)
(225) 665-8606
Entity
Organization
Contact information
Practice address
257 FLORIDA AVE SE, STE B, DENHAM SPRINGS, LA 70726-3728
(225) 665-8606
(225) 664-4043
Mailing address
257 FLORIDA AVE SE, STE B, DENHAM SPRINGS, LA 70726-3728
(225) 665-8606
(225) 664-4043
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
5128-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1270920
—
LA
01
—
2035170
PK
—
Enumeration date
08/10/2006
Last updated
12/21/2016
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