Provider Demographics
NPI:1033403191
Name:DAMASIUS INC
Entity Type:Organization
Organization Name:DAMASIUS INC
Other - Org Name:VYTO'S PHARMACY 3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:DAMASIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:219-845-2900
Mailing Address - Street 1:4923 HOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1275
Mailing Address - Country:US
Mailing Address - Phone:219-937-1600
Mailing Address - Fax:219-937-7268
Practice Address - Street 1:4923 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1275
Practice Address - Country:US
Practice Address - Phone:219-937-1600
Practice Address - Fax:219-937-7268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAMASIUS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-07
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IN60006313A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201089770AMedicaid
2136373OtherPK
2136373OtherPK