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General NPI Number Information
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NPI Number | 1164705968
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Entity Type | Organization
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Legal Business Name | KHADER DAVID PHARMACY & SERVICES LLC
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 102 E CARMEL DR
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City | CARMEL
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State | IN
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Zip | 46032-2633
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Country | US
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Telephone | 317-573-4004
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Fax | 317-573-4003
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Provider Business Mailing Address
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Address Line | 102 E CARMEL DR
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City | CARMEL
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State | IN
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Zip | 46032-2633
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Country | US
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Telephone | 317-573-4004
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Fax | 317-573-4003
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DELFIN DAVID
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Credential |
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Telephone | 317-640-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 60006272A
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License Number State | IN
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