Provider Demographics
NPI:1275513707
Name:HEALTH PROFESSIONAL RESOURCES INC
Entity Type:Organization
Organization Name:HEALTH PROFESSIONAL RESOURCES INC
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-732-0418
Mailing Address - Street 1:1201 MICHIGAN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1580
Mailing Address - Country:US
Mailing Address - Phone:574-732-0418
Mailing Address - Fax:574-753-8549
Practice Address - Street 1:1201 MICHIGAN AVE
Practice Address - Street 2:STE 100
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1580
Practice Address - Country:US
Practice Address - Phone:574-732-0418
Practice Address - Fax:574-753-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004263B333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100294260AMedicaid
2027371OtherPK
IN100294260AMedicaid