Provider Demographics
NPI:1003332495
Name:CROSSROADS CARE PHARMACY LLC
Entity Type:Organization
Organization Name:CROSSROADS CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-720-2569
Mailing Address - Street 1:6176 S COUNTY ROAD 250 E
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-8728
Mailing Address - Country:US
Mailing Address - Phone:765-795-7611
Mailing Address - Fax:
Practice Address - Street 1:209 EAST PAT RADY WAY
Practice Address - Street 2:SUITE B
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105
Practice Address - Country:US
Practice Address - Phone:765-522-4300
Practice Address - Fax:765-522-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy