MEDICARE: DEKALB MEMORIAL PHARMACARE 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	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	60006238A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2129458	OTHER		PK

General Provider Information

NPI Number	:	1720126295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKALB MEMORIAL PHARMACARE LLC

Provider Business Mailing Address
First Line	:	1314 E 7TH ST STE 104
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-2533
Country	:	US
Telephone Number	:	260-925-8000
Fax Number	:	260-925-9500

Provider Business Practice Location Address
First Line	:	1314 E 7TH ST STE 104
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-2533
Country	:	US
Telephone Number	:	260-925-8000
Fax Number	:	260-925-9500

Authorized Official
Title or Position	:	CFO
Name	:	MRS. JESSICA LEE-HANSEN
Credential	:
Telephone Number	:	312-388-0125

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	03/02/2026

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