Healthcare Provider Details

I. General information

NPI: 1336465103
Provider Name (Legal Business Name): BKD PRODUCTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 CHIMNEYLAKE DR
LAFAYETTE IN
47905-7667
US

IV. Provider business mailing address

5123 CHIMNEYLAKE DR
LAFAYETTE IN
47905-7667
US

V. Phone/Fax

Practice location:
  • Phone: 765-418-7320
  • Fax:
Mailing address:
  • Phone: 765-418-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. BRIAN KEITH DADE
Title or Position: OWNER/ CEO
Credential:
Phone: 765-418-7320