Healthcare Provider Details

I. General information

NPI: 1235384827
Provider Name (Legal Business Name): MARWOOD LOW COST PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3381 KENTUCKY AVE
INDIANAPOLIS IN
46221-2305
US

IV. Provider business mailing address

3381 KENTUCKY AVE
INDIANAPOLIS IN
46221-2305
US

V. Phone/Fax

Practice location:
  • Phone: 317-246-6700
  • Fax:
Mailing address:
  • Phone: 317-246-6700
  • Fax:

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 TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60006189A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: METHQAL ABU-MAHFOUZ
Title or Position: PHARMACIST
Credential:
Phone: 317-590-1271