Provider Demographics
NPI:1114300340
Name:FRANCISCAN ALLIANCE, INC
Entity Type:Organization
Organization Name:FRANCISCAN ALLIANCE, INC
Other - Org Name:FRANCISCAN OUTPATIENT PHARMACY-LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR-AMBULATORY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BITNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-528-6047
Mailing Address - Street 1:1701 S CREASY LN
Mailing Address - Street 2:ROOM 1K71
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4972
Mailing Address - Country:US
Mailing Address - Phone:765-428-3550
Mailing Address - Fax:765-428-3551
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:ROOM 1K71
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-428-3550
Practice Address - Fax:765-428-3551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN ALLIANCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-07
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201341420Medicaid