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General NPI Number Information
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NPI Number | 1265880389
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Entity Type | Organization
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Legal Business Name | PURDUE GMP CENTER
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 3070 KENT AVE
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1075
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Country | US
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Telephone | 765-464-8414
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Fax | 765-464-8408
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Provider Business Mailing Address
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Address Line | 3070 KENT AVE
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1075
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Country | US
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Telephone | 765-464-8414
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Fax | 765-464-8408
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Authorized Official
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Title or Position | PRODUCTION COORDINATOR
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Name | MRS. KIMBERLY S NEWBAUER
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Credential |
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Telephone | 765-464-8414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 332900000X
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License Number State | IN
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