Healthcare Provider Details

I. General information

NPI: 1750697645
Provider Name (Legal Business Name): IBP PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 INDIANAPOLIS BLVD
WHITING IN
46394-1948
US

IV. Provider business mailing address

2075 INDIANAPOLIS BLVD
WHITING IN
46394-1948
US

V. Phone/Fax

Practice location:
  • Phone: 219-659-5047
  • Fax: 219-659-5039
Mailing address:
  • Phone: 219-659-5029
  • Fax: 219-659-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006224A
License Number StateIN

VIII. Authorized Official

Name: NATASHA BANKS
Title or Position: PRESIDENT
Credential:
Phone: 708-552-7683