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General NPI Number Information
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NPI Number | 1003802455
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Entity Type | Organization
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Legal Business Name | HEART CITY HEALTH CENTER PHARMACY
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 236 SIMPSON AVE
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City | ELKHART
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State | IN
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Zip | 46516-4671
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Country | US
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Telephone | 574-970-1441
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Fax | 574-970-1449
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Provider Business Mailing Address
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Address Line | 236 SIMPSON AVE
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City | ELKHART
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State | IN
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Zip | 46516-4671
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Country | US
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Telephone | 574-970-1441
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Fax | 574-970-1449
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Authorized Official
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Title or Position | QUALIFYING PHARMACIST
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Name | EUGENIO EDWARDO VALDEZ
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Credential |
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Telephone | 574-970-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 60005127A
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License Number State | IN
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