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General NPI Number Information
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NPI Number | 1235197773
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Entity Type | Organization
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Legal Business Name | PHARMA-CARD WEST, INC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 5500 HOHMAN AVE
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City | HAMMOND
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State | IN
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Zip | 46320-1965
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Country | US
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Telephone | 219-932-2920
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Fax | 219-933-2194
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Provider Business Mailing Address
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Address Line | PO BOX 1637
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City | VALPARAISO
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State | IN
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Zip | 46384-1637
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Country | US
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Telephone | 219-464-0404
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Fax | 219-465-0333
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD S BRYCHELL
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Credential | RPH
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Telephone | 219-464-0404
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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 | 60005324A
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License Number State | IN
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