Provider Demographics
NPI:1093117426
Name:INDIANA PREMIER PHARMACY
Entity Type:Organization
Organization Name:INDIANA PREMIER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GHADA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EL-BOLKINY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-828-1280
Mailing Address - Street 1:8395 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038
Mailing Address - Country:US
Mailing Address - Phone:317-288-0400
Mailing Address - Fax:
Practice Address - Street 1:8395 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1520
Practice Address - Country:US
Practice Address - Phone:317-288-0400
Practice Address - Fax:317-288-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy