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General NPI Number Information
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NPI Number | 1376941344
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Entity Type | Organization
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Legal Business Name | SOUTH BEND SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 07/21/2019
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Provider Practice Location Address
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Address Line | 54590 IRONWOOD RD
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City | SOUTH BEND
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State | IN
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Zip | 46635-1617
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Country | US
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Telephone | 574-968-3717
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Fax | 574-314-6916
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Provider Business Mailing Address
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Address Line | 54590 IRONWOOD RD
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City | SOUTH BEND
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State | IN
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Zip | 46635-1617
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Country | US
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Telephone | 574-807-6170
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Fax | 877-235-7012
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Authorized Official
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Title or Position | OWNER
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Name | ELAINE ALMEIDA
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Credential |
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Telephone | 574-968-3717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60006503A
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License Number State | IN
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