Provider Demographics
NPI:1407919806
Name:HOMEMED PHARMACY
Entity Type:Organization
Organization Name:HOMEMED PHARMACY
Other - Org Name:HOMEMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-616-4500
Mailing Address - Street 1:534 W CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:866-466-3633
Mailing Address - Fax:866-243-5900
Practice Address - Street 1:534 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:866-466-3633
Practice Address - Fax:866-243-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60066059A333600000X, 333600000X
IN15335173336C0003X, 3336M0002X, 320800000X, 332800000X, 332900000X, 333600000X, 3336C0003X, 3336M0002X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1533517Medicare ID - Type UnspecifiedMEDICARE PART D PROVIDER
IN1533517Medicare ID - Type UnspecifiedMEDICARE PART A & B