=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356667109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STATE OF INDIANA, AUDITOR OF STATE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2010
-----------------------------------------------------
Last Update Date | 04/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3851 N RIVER RD PHARMACY DEPARTMENT
-----------------------------------------------------
City | WEST LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47906-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-497-8642
-----------------------------------------------------
Fax | 765-497-8593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3851 N RIVER RD PHARMACY DEPARTMENT
-----------------------------------------------------
City | WEST LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47906-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-497-8642
-----------------------------------------------------
Fax | 765-497-8593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DCOS LEGISLATIVE DIRECTOR
-----------------------------------------------------
Name | DANIELLE CHRYSLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-232-7566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | 60000339A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------