Healthcare Provider Details

I. General information

NPI: 1003973314
Provider Name (Legal Business Name): MERIDIAN NORTH PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 N MERIDIAN ST STE 106 B
INDIANAPOLIS IN
46260-5381
US

IV. Provider business mailing address

9002 N MERIDIAN ST STE 106 B
INDIANAPOLIS IN
46260-5381
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-6654
  • Fax: 317-846-3038
Mailing address:
  • Phone: 317-846-6654
  • Fax: 317-846-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60003615A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA JAMES
Title or Position: OWNER
Credential:
Phone: 317-846-6654