Provider Demographics
NPI:1114177235
Name:INDIANA UNIVERSITY HEALTH, INC.
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH, INC.
Other - Org Name:EAST RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-962-2380
Mailing Address - Street 1:1776 N MERIDIAN ST
Mailing Address - Street 2:STE 100A RETAIL PHARMACY ADMIN
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1468
Mailing Address - Country:US
Mailing Address - Phone:317-963-9730
Mailing Address - Fax:317-963-5003
Practice Address - Street 1:9650 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3032
Practice Address - Country:US
Practice Address - Phone:317-890-5527
Practice Address - Fax:317-890-5675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006253A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60006253AOtherSTATE
IN200003770Medicaid
INFI2597752OtherDEA
IN1133670021Medicare NSC