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General NPI Number Information
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NPI Number | 1164090825
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Entity Type | Organization
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Legal Business Name | BLUE RIVER PHARMACY INC
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 26 S GREEN ST
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City | BROWNSBURG
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State | IN
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Zip | 46112-1251
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Country | US
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Telephone | 317-286-3506
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Fax | 317-350-2917
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Provider Business Mailing Address
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Address Line | 26 S GREEN ST
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City | BROWNSBURG
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State | IN
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Zip | 46112-1251
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Country | US
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Telephone | 317-286-3506
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Fax | 317-350-2917
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL CRUZAN
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Credential |
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Telephone | 317-286-3506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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