Provider Demographics
NPI:1124192521
Name:CHRONISTER KENDALLVILLE DRUG
Entity Type:Organization
Organization Name:CHRONISTER KENDALLVILLE DRUG
Other - Org Name:CHRONISTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:260-347-0660
Mailing Address - Street 1:318 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-1004
Mailing Address - Country:US
Mailing Address - Phone:260-347-0660
Mailing Address - Fax:260-347-3638
Practice Address - Street 1:318 W NORTH ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1004
Practice Address - Country:US
Practice Address - Phone:260-347-0660
Practice Address - Fax:260-347-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60003950A333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1508350OtherNCPCP
IN0575870001Medicare ID - Type Unspecified