Healthcare Provider Details

I. General information

NPI: 1013542356
Provider Name (Legal Business Name): VIRAG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E BOW STREET INSIDE WITHAM CLINIC
THORNTOWN IN
46071
US

IV. Provider business mailing address

1001 W MAIN ST
CARMEL IN
46032-1433
US

V. Phone/Fax

Practice location:
  • Phone: 765-889-4735
  • Fax: 765-548-5736
Mailing address:
  • Phone: 317-688-7050
  • Fax: 317-575-1094

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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SAUMIIN CALCUTTAWALA
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD, MS
Phone: 317-688-7050