Provider Demographics
NPI:1225380926
Name:FRANCISCAN ALLIANCE, INC.
Entity Type:Organization
Organization Name:FRANCISCAN ALLIANCE, INC.
Other - Org Name:FRANCISCAN HOME INFUSION PHARMACY MUNSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-254-6252
Mailing Address - Street 1:757 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2911
Mailing Address - Country:US
Mailing Address - Phone:219-407-6894
Mailing Address - Fax:219-836-2464
Practice Address - Street 1:757 45TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2911
Practice Address - Country:US
Practice Address - Phone:219-836-1899
Practice Address - Fax:219-836-2464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN ALLIANCE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-05
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006315A332B00000X, 333600000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201199900AMedicaid
IN6723650001Medicare NSC