Provider Demographics
NPI:1356667109
Name:STATE OF INDIANA, AUDITOR OF STATE
Entity Type:Organization
Organization Name:STATE OF INDIANA, AUDITOR OF STATE
Other - Org Name:INDIANA VETERANS' HOME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DCOS LEGISLATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRYSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-232-7566
Mailing Address - Street 1:3851 N RIVER RD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-3762
Mailing Address - Country:US
Mailing Address - Phone:765-497-8642
Mailing Address - Fax:765-497-8593
Practice Address - Street 1:3851 N RIVER RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3762
Practice Address - Country:US
Practice Address - Phone:765-497-8642
Practice Address - Fax:765-497-8593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF INDIANA, AUDITOR OF STATE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60000339A3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy