Provider Demographics
NPI:1164705968
Name:KHADER DAVID PHARMACY & SERVICES LLC
Entity Type:Organization
Organization Name:KHADER DAVID PHARMACY & SERVICES LLC
Other - Org Name:VALUSCRIPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DELFIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-640-5155
Mailing Address - Street 1:102 E CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2633
Mailing Address - Country:US
Mailing Address - Phone:317-573-4004
Mailing Address - Fax:317-573-4003
Practice Address - Street 1:102 E CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2633
Practice Address - Country:US
Practice Address - Phone:317-573-4004
Practice Address - Fax:317-573-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006272A333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1563483OtherNCPDP PROVIDER IDENTIFICATION NUMBER