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General NPI Number Information
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NPI Number | 1780788927
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Entity Type | Organization
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Legal Business Name | CLOVERDALE DRUGS, INC
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 900 N MAIN ST
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City | CLOVERDALE
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State | IN
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Zip | 46120-8506
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Country | US
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Telephone | 765-795-4100
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Fax | 765-795-5310
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Provider Business Mailing Address
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Address Line | PO BOX 357
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City | CLOVERDALE
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State | IN
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Zip | 46120-0357
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Country | US
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Telephone | 765-795-4100
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Fax | 765-795-5310
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Authorized Official
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Title or Position | OWNER
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Name | KENNEDY RYAN
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Credential |
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Telephone | 765-795-4100
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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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