Provider Demographics
NPI:1023012044
Name:UCH PHARMACEUTICAL SERVICES INC
Entity Type:Organization
Organization Name:UCH PHARMACEUTICAL SERVICES INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:URBIN
Authorized Official - Middle Name:GUTHRIE
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:765-664-6100
Mailing Address - Street 1:715 S BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-1375
Mailing Address - Country:US
Mailing Address - Phone:765-664-6100
Mailing Address - Fax:765-664-7882
Practice Address - Street 1:715 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-1375
Practice Address - Country:US
Practice Address - Phone:765-664-6100
Practice Address - Fax:765-664-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004464A333600000X
IN3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1531513OtherNCPDP #
IN100466610AMedicaid
IN100466610AMedicaid
INTA6090Medicare PIN
IN0923970001Medicare NSC
INP00233077Medicare PIN