1528333648 NPI number — INDIANA UNIVERSITY HEALTH ARNETT INC

Table of content: (NPI 1528333648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528333648 NPI number — INDIANA UNIVERSITY HEALTH ARNETT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH ARNETT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IU HEALTH ARNETT RETAIL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528333648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7264 SOLUTIONS CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60686-0072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-962-1522
Provider Business Mailing Address Fax Number:
317-963-5003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5165 MCCARTY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-8764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-448-8625
Provider Business Practice Location Address Fax Number:
765-448-8190
Provider Enumeration Date:
03/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
RETAIL PHARMACY MANAGER
Authorized Official Telephone Number:
765-448-8900

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 60006294A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201070690A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2134048 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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