Healthcare Provider Details

I. General information

NPI: 1376452433
Provider Name (Legal Business Name): ELI OPACICH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514-2499
US

IV. Provider business mailing address

57736 FALL CREEK DR
GOSHEN IN
46528-6128
US

V. Phone/Fax

Practice location:
  • Phone: 574-389-4864
  • Fax:
Mailing address:
  • Phone: 765-532-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number26022892A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: