| NPI | 1790859403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUDY K WAIT Manager 574-647-8674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy |
| Additional Taxonomies | 251F00000X Home Infusion (Licence: IN 60004143A) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IN 69000137A) | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2021-12-14 |