Provider Demographics
NPI:1083341366
Name:ELLA COMMUNITY PHARMACY 1, LLC
Entity Type:Organization
Organization Name:ELLA COMMUNITY PHARMACY 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:317-896-9378
Mailing Address - Street 1:20505 FREEMONT MOORE RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-9155
Mailing Address - Country:US
Mailing Address - Phone:317-896-9378
Mailing Address - Fax:
Practice Address - Street 1:211 JERSEY ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9187
Practice Address - Country:US
Practice Address - Phone:317-896-9378
Practice Address - Fax:317-896-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300007606Medicaid