| NPI | 1508695891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA KAY LOWERY Credentialing Manager 317-919-9025 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2026-07-04 |