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
1	3336C0002X	Clinic Pharmacy

General Provider Information

NPI Number	:	1548045065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIVIO PHARMACY, LLC

Provider Business Mailing Address
First Line	:	4010 W GOELLER BLVD STE C
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8312
Country	:	US
Telephone Number	:	812-799-0589
Fax Number	:	812-418-8710

Provider Business Practice Location Address
First Line	:	4010 W GOELLER BLVD STE C
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8312
Country	:	US
Telephone Number	:	812-799-0589
Fax Number	:	812-418-8710

Authorized Official
Title or Position	:	PIC
Name	:	ERIKA DURAN
Credential	:
Telephone Number	:	812-346-4834

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	08/31/2023

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