Provider Demographics
NPI:1073654687
Name:BROAD-RIDGE DRUG,INC
Entity Type:Organization
Organization Name:BROAD-RIDGE DRUG,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ONWUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RPH
Authorized Official - Phone:219-884-4445
Mailing Address - Street 1:3776 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-2203
Mailing Address - Country:US
Mailing Address - Phone:219-884-4445
Mailing Address - Fax:219-884-4480
Practice Address - Street 1:3776 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-2203
Practice Address - Country:US
Practice Address - Phone:219-884-4445
Practice Address - Fax:219-884-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005393A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy