Provider Demographics
NPI:1275616351
Name:FRANCISCAN ALLIANCE, INC
Entity Type:Organization
Organization Name:FRANCISCAN ALLIANCE, INC
Other - Org Name:FRANCISCAN HOME INFUSION PHARMACY LAFAYETTE
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 1:1501 HARTFORD ST STE G540
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2134
Mailing Address - Country:US
Mailing Address - Phone:765-423-6540
Mailing Address - Fax:765-423-6640
Practice Address - Street 1:1501 HARTFORD ST STE G540
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2134
Practice Address - Country:US
Practice Address - Phone:765-423-6540
Practice Address - Fax:765-423-6640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN ALLIANCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005568A3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1531006OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IN100233060Medicaid
IN100233060Medicaid