Provider Demographics
NPI:1427040302
Name:OFFERLE APOTHECARY INC.
Entity Type:Organization
Organization Name:OFFERLE APOTHECARY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-424-6743
Mailing Address - Street 1:2413 HOBSON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2917
Mailing Address - Country:US
Mailing Address - Phone:260-424-6743
Mailing Address - Fax:260-422-1855
Practice Address - Street 1:2413 HOBSON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-2917
Practice Address - Country:US
Practice Address - Phone:260-424-6743
Practice Address - Fax:260-422-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0022263670021332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100293460Medicaid
IN0211010001Medicare NSC