Provider Demographics
NPI:1114995784
Name:INDIANA UNIVERSITY HEALTH INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH INC
Other - Org Name:WEST RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN DIR-RETAIL PHARMACY OPS
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-751-5316
Mailing Address - Street 1:3988 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3009
Mailing Address - Country:US
Mailing Address - Phone:317-963-9730
Mailing Address - Fax:317-963-5003
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-3355
Practice Address - Fax:317-217-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60006416A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200483870AMedicaid
2149477OtherPK
2149477OtherPK
IN200483870AMedicaid