Healthcare Provider Details

I. General information

NPI: 1215914700
Provider Name (Legal Business Name): HOLLONS PANORAMA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 E 10TH ST
ANDERSON IN
46012-4409
US

IV. Provider business mailing address

2517 E 10TH ST
ANDERSON IN
46012-4409
US

V. Phone/Fax

Practice location:
  • Phone: 765-644-8851
  • Fax: 336-861-0173
Mailing address:
  • Phone: 765-644-8851
  • Fax: 336-861-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60003770
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SANDRE BUTLER
Title or Position: MANAGER
Credential:
Phone: 765-644-8851