Provider Demographics
NPI:1689372393
Name:MED CHOICE LTC PHARMACY LLC
Entity type:Organization
Organization Name:MED CHOICE LTC PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRATAP
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:ANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-298-1715
Mailing Address - Street 1:3838 SHERMAN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4001
Mailing Address - Country:US
Mailing Address - Phone:951-637-3399
Mailing Address - Fax:
Practice Address - Street 1:2222 E ORANGEBURG AVE STE B3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3472
Practice Address - Country:US
Practice Address - Phone:209-298-1715
Practice Address - Fax:559-369-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60512OtherPHARMACY LICENSE