=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558355537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MHP PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W 103RD ST INH 515
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46290-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-852-1553
-----------------------------------------------------
Fax | 888-852-1759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 W 103RD ST INH 515
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46290-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-852-1553
-----------------------------------------------------
Fax | 888-852-1759
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BARRY JOHN HART
-----------------------------------------------------
Credential | R PH
-----------------------------------------------------
Telephone | 317-213-5117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 60005853
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------