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General NPI Number Information
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NPI Number | 1972794816
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Entity Type | Organization
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Legal Business Name | PLYMOUTH TOWNE CARE PHARMACY INC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 2855 MILLER DR STE 111
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City | PLYMOUTH
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State | IN
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Zip | 46563-8091
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Country | US
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Telephone | 574-941-1067
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Fax | 574-941-1076
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Provider Business Mailing Address
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Address Line | 2855 MILLER DR STE 111
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City | PLYMOUTH
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State | IN
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Zip | 46563-8091
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES ORENDOR
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Credential |
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Telephone | 574-930-3167
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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 | 60006058A
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License Number State | IN
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