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NPI Code Detail

MEDICARE: ALIVIO PHARMACY, LLC

MEDICARE: ALIVIO PHARMACY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy054.019801IL
23336C0004XCompounding Pharmacy60006279AIN
33336M0002XMail Order Pharmacy
43336C0003XCommunity/Retail PharmacyPH30179FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12133084OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356610299
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALIVIO PHARMACY, LLC
Provider Business Mailing Address
First Line : 2060 N SHADELAND AVE STE 101
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-1764
Country : US
Telephone Number : 317-354-8160
Fax Number : 317-354-8162
Provider Business Practice Location Address
First Line : 2060 N SHADELAND AVE STE 101
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-1764
Country : US
Telephone Number : 317-354-8160
Fax Number : 317-354-8162
Authorized Official
Title or Position : PIC
Name : ERIKA DURAN
Credential :
Telephone Number : 317-354-8160
Provider Enumeration Date : 12/21/2011
Last Update Date : 08/31/2023

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Directions to “ALIVIO PHARMACY, LLC ” Practice Location

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