Healthcare Provider Details

I. General information

NPI: 1295877694
Provider Name (Legal Business Name): HOOSIER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 HOHMAN AVE.
HAMMOND IN
46327-1160
US

IV. Provider business mailing address

3833 HOHMAN AVE.
HAMMOND IN
46327-1160
US

V. Phone/Fax

Practice location:
  • Phone: 219-931-7070
  • Fax: 219-931-1235
Mailing address:
  • Phone: 219-931-7070
  • Fax: 219-931-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60000203A
License Number StateIN

VIII. Authorized Official

Name: MR. EDWARD G VISCHAK
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 219-931-7070