Provider Demographics
NPI:1225179682
Name:NSPB CORP DBA HOLIDAY PHARMACY
Entity Type:Organization
Organization Name:NSPB CORP DBA HOLIDAY PHARMACY
Other - Org Name:HOLIDAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:R,PH
Authorized Official - Phone:812-429-0711
Mailing Address - Street 1:1202 W BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5185
Mailing Address - Country:US
Mailing Address - Phone:812-429-0711
Mailing Address - Fax:812-429-1784
Practice Address - Street 1:1202 W BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5185
Practice Address - Country:US
Practice Address - Phone:812-429-0711
Practice Address - Fax:812-429-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60003294A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1516523OtherNCPDP
IN60003294AOtherPHARMACY PERMIT
INBH0595821OtherDEA REGISTRATION
INBH0595821OtherDEA REGISTRATION