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General NPI Number Information
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NPI Number | 1609201730
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Entity Type | Organization
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Legal Business Name | CM SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 5510 LAFAYETTE RD STE 260
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-1691
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Country | US
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Telephone | 317-803-2069
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Fax | 317-293-1836
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Provider Business Mailing Address
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Address Line | 6005 W 71ST ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1705
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Country | US
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Telephone | 317-803-3436
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Fax | 317-803-3437
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | JEFF JACKSON
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Credential |
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Telephone | 317-803-2069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 60006341A
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License Number State | IN
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