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General NPI Number Information
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NPI Number | 1710064886
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Entity Type | Organization
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Legal Business Name | HCMH DIVERSIFIED MANAGEMENT CORP
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 2200 FOREST RIDGE PKWY
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City | NEW CASTLE
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State | IN
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Zip | 47362-2943
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Country | US
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Telephone | 765-599-3540
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Fax | 765-599-3541
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Provider Business Mailing Address
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Address Line | 2200 FOREST RIDGE PKWY
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City | NEW CASTLE
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State | IN
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Zip | 47362-2943
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Country | US
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Telephone | 765-599-3540
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Fax | 765-599-3541
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Authorized Official
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Title or Position | MANAGER
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Name | RACHEL BURNS
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Credential | RPH
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Telephone | 765-529-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60005462A
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License Number State | IN
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