Organization
BROADWAY LTC PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CARROLL PHARMD (CEO)
(916) 364-2418
Entity
Organization
Contact information
Practice address
3330 BROADWAY, SACRAMENTO, CA 95817-2840
(916) 452-8022
(916) 452-6326
Mailing address
4545 HARLIN DR, SACRAMENTO, CA 95826-9716
(916) 364-2416
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHY44334
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA443340
—
CA
Enumeration date
09/08/2005
Last updated
08/22/2020
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