Healthcare Provider Details

I. General information

NPI: 1972794816
Provider Name (Legal Business Name): PLYMOUTH TOWNE CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 MILLER DR STE 111
PLYMOUTH IN
46563-8091
US

IV. Provider business mailing address

2855 MILLER DR STE 111
PLYMOUTH IN
46563-8091
US

V. Phone/Fax

Practice location:
  • Phone: 574-941-1067
  • Fax: 574-941-1076
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006058A
License Number StateIN

VIII. Authorized Official

Name: JAMES ORENDOR
Title or Position: PRESIDENT
Credential:
Phone: 574-930-3167