Provider Demographics
NPI:1235349622
Name:PHARMACORR, LLC
Entity Type:Organization
Organization Name:PHARMACORR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-299-3426
Mailing Address - Street 1:6002 CORPORATE WAY
Mailing Address - Street 2:BLDG B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2923
Mailing Address - Country:US
Mailing Address - Phone:317-299-3426
Mailing Address - Fax:317-299-3751
Practice Address - Street 1:6002 CORPORATE WAY
Practice Address - Street 2:BLDG B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2923
Practice Address - Country:US
Practice Address - Phone:317-299-3426
Practice Address - Fax:317-299-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005768A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty