Provider Demographics
NPI:1134130644
Name:CHS COMMUNITY PHARMACY NETWORK LLC
Entity Type:Organization
Organization Name:CHS COMMUNITY PHARMACY NETWORK LLC
Other - Org Name:MARION HEALTHCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR ADMIN DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:765-751-5316
Mailing Address - Street 1:RX ADMINISTRATION OFFICE
Mailing Address - Street 2:2401 W. UNIVERSITY AVE
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303
Mailing Address - Country:US
Mailing Address - Phone:765-751-5316
Mailing Address - Fax:765-741-1950
Practice Address - Street 1:RX ADMINISTRATION OFFICE
Practice Address - Street 2:2401 W. UNIVERSITY AVE
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303
Practice Address - Country:US
Practice Address - Phone:765-751-5316
Practice Address - Fax:765-741-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60005329A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200198990Medicaid
1533822OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5445990006Medicare NSC