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General NPI Number Information
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NPI Number | 1912900275
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Entity Type | Organization
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Legal Business Name | FAIRMEADOWS PHARMACY INC
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 800 MACARTHUR BLVD
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City | MUNSTER
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State | IN
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Zip | 46321-2985
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Country | US
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Telephone | 219-836-8700
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Fax | 219-836-7639
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Provider Business Mailing Address
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Address Line | PO BOX 3395
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City | MUNSTER
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State | IN
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Zip | 46321-0395
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Country | US
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Telephone | 219-836-8700
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Fax | 219-836-7639
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DANIEL ZURAWSKI
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Credential | RPH
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Telephone | 219-836-8700
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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 | 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 #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 60002227A
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License Number State | IN
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