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General NPI Number Information
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NPI Number | 1811021629
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Entity Type | Organization
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Legal Business Name | MEIJER 155
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2507 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1105
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Country | US
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Telephone | 765-939-4433
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Fax | 765-939-4465
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Provider Business Mailing Address
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Address Line | 2507 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1105
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Country | US
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Telephone | 765-939-4433
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Fax | 765-939-4465
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. DAN HUFFMAN
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Credential | RPH
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Telephone | 765-939-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26020092A
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License Number State | IN
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