Healthcare Provider Details

I. General information

NPI: 1447438239
Provider Name (Legal Business Name): NRS PHARMACIES OF INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N FOOTE ST
CAMBRIDGE CITY IN
47327-1104
US

IV. Provider business mailing address

100 N FOOTE ST
CAMBRIDGE CITY IN
47327-1104
US

V. Phone/Fax

Practice location:
  • Phone: 765-334-8331
  • Fax: 765-334-8331
Mailing address:
  • Phone: 765-334-8331
  • Fax: 765-334-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006344A
License Number StateIN

VIII. Authorized Official

Name: STEPHEN SOMMER
Title or Position: VICE PRESIDENT FINANCE/AO
Credential:
Phone: 314-965-4700