| NPI | 1336223171 |
|---|---|
| Doing Business As | PROVIDENCE SPECIALTY PHARMACY SERVICES-LTC |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: OR IP0001899-CS) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-11-02 |