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General NPI Number Information
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NPI Number | 1639620669
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Entity Type | Organization
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Legal Business Name | DEKALB MEMORIAL PHARMACARE LLC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1350 S RANDOLPH ST
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City | GARRETT
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State | IN
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Zip | 46738-1971
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Country | US
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Telephone | 260-553-9200
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Fax | 260-553-9201
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Provider Business Mailing Address
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Address Line | 1350 S RANDOLPH ST
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City | GARRETT
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State | IN
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Zip | 46738-1971
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Country | US
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Telephone | 260-553-9200
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Fax | 260-553-9201
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Authorized Official
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Title or Position | ACFO
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Name | STANTON RISSER
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Credential |
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Telephone | 260-266-9380
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60006582A
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License Number State | IN
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