Healthcare Provider Details

I. General information

NPI: 1790142255
Provider Name (Legal Business Name): CAMBY LOW COST PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 WINDFALL LN STE 90
CAMBY IN
46113-8027
US

IV. Provider business mailing address

8411 WINDFALL LN STE 90
CAMBY IN
46113-8027
US

V. Phone/Fax

Practice location:
  • Phone: 317-548-8015
  • Fax: 317-830-8365
Mailing address:
  • Phone: 317-548-8015
  • Fax: 317-830-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60006559A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AKRAM ABUMAHFOUZ
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential:
Phone: 317-548-8015