Provider Demographics
NPI:1295839462
Name:LOCAL HEALTH INDIANA INC.
Entity Type:Organization
Organization Name:LOCAL HEALTH INDIANA INC.
Other - Org Name:DBA BRISTOL PHARMACY FORMER NAME JAI CHAMUNDA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP RDO
Authorized Official - Prefix:
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DZELIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:815-715-8502
Mailing Address - Street 1:300 E ELKHART
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IN
Mailing Address - Zip Code:46507
Mailing Address - Country:US
Mailing Address - Phone:815-715-8502
Mailing Address - Fax:574-848-0663
Practice Address - Street 1:300 E ELKHART
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:IN
Practice Address - Zip Code:46507
Practice Address - Country:US
Practice Address - Phone:815-715-8502
Practice Address - Fax:574-848-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005839A332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200126860AMedicaid
1537135OtherNCPDP
IN1102760002Medicare NSC
IN1102760002Medicare ID - Type Unspecified