Provider Demographics
NPI:1083188973
Name:CIRCLE CITY PHARMACY, LLC
Entity Type:Organization
Organization Name:CIRCLE CITY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-696-6668
Mailing Address - Street 1:65 E GARNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7867
Mailing Address - Country:US
Mailing Address - Phone:800-211-6540
Mailing Address - Fax:800-211-6540
Practice Address - Street 1:65 E GARNER RD STE 200
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7867
Practice Address - Country:US
Practice Address - Phone:800-211-6540
Practice Address - Fax:800-211-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy