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A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO?s covered members only.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Managed Care Organization Pharmacy |
3336M0003X | 58 | Medical Supply Company with Pharmacist | |
Clinic Pharmacy |
3336C0002X | 58 | Medical Supply Company with Pharmacist |
| NPI Number | 1790997773 |
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| LBN Legal business name | HEALTHSPAN INTEGRATED CARE | ||||||||
| Authorized official | MELANIE ROLSEN - (MGR, PHARM BUSINESS) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/04/2007 | ||||||||
| Last updated | 05/07/2014 - About 12 years ago | ||||||||
| Identifiers |
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HEALTHSPAN INTEGRATED CARE