Provider Demographics
NPI:1407624257
Name:RIGGS COMMUNITY HEALTH CENTER PHARMACY, LLC
Entity Type:Organization
Organization Name:RIGGS COMMUNITY HEALTH CENTER PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BAMBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUADE-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:765-742-1567
Mailing Address - Street 1:1716 HARTFORD ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904
Mailing Address - Country:US
Mailing Address - Phone:765-663-0200
Mailing Address - Fax:
Practice Address - Street 1:1716 HARTFORD ST
Practice Address - Street 2:STE 100
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904
Practice Address - Country:US
Practice Address - Phone:657-663-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIGGS COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-12
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60006913BOtherIN STATE LICENSE
IN60006913AOtherIN STATE LICENSE