MEDICARE: LILLYDIRECT PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1912889320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILLYDIRECT PHARMACY, LLC

Provider Business Mailing Address
First Line	:	1555 S HARDING ST STE 171-B68
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-1873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 S HARDING ST STE 171-B68
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-1873
Country	:	US
Telephone Number	:	317-276-0600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN HAUG
Credential	:
Telephone Number	:	317-276-2000

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	07/24/2025

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