Provider Demographics
NPI:1073670410
Name:BALL STATE HEALTHCENTER PHARMACY
Entity Type:Organization
Organization Name:BALL STATE HEALTHCENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR, CHS COMMUNITY PHARMACY NETWORK
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:765-751-5316
Mailing Address - Street 1:1500 NEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47306-0001
Mailing Address - Country:US
Mailing Address - Phone:765-285-1079
Mailing Address - Fax:765-285-1138
Practice Address - Street 1:1500 NEELEY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-0001
Practice Address - Country:US
Practice Address - Phone:765-285-1079
Practice Address - Fax:765-285-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015999A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty