Provider Demographics
NPI:1376816744
Name:AFFORDABLE RX HEALTHMART & HOME MEDICAL EQUIPMENTS LLC
Entity Type:Organization
Organization Name:AFFORDABLE RX HEALTHMART & HOME MEDICAL EQUIPMENTS LLC
Other - Org Name:AFFORDABLE RX HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OPE
Authorized Official - Middle Name:ADENIKE
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:131-787-9551
Mailing Address - Street 1:1635 E SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5213
Mailing Address - Country:US
Mailing Address - Phone:317-879-5514
Mailing Address - Fax:317-534-3776
Practice Address - Street 1:1635 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5213
Practice Address - Country:US
Practice Address - Phone:317-879-5514
Practice Address - Fax:317-534-3776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFORDABLE RX HEALTHMART & HOME MEDICAL EQUIPMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-16
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60006289A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006326Medicaid
IN201055320AMedicaid