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General NPI Number Information
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NPI Number | 1225179682
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Entity Type | Organization
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Legal Business Name | NSPB CORP DBA HOLIDAY PHARMACY
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1202 W BUENA VISTA RD
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City | EVANSVILLE
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State | IN
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Zip | 47710-5185
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Country | US
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Telephone | 812-429-0711
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Fax | 812-429-1784
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Provider Business Mailing Address
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Address Line | 1202 W BUENA VISTA RD
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City | EVANSVILLE
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State | IN
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Zip | 47710-5185
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Country | US
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Telephone | 812-429-0711
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Fax | 812-429-1784
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL L MCFADDEN
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Credential | R,PH.
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Telephone | 812-429-0711
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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 | 60003294A
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License Number State | IN
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