Provider Demographics
NPI:1437117686
Name:PHARMA - CARD INC
Entity Type:Organization
Organization Name:PHARMA - CARD INC
Other - Org Name:PHARMA CARD VALPARAISO NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-464-0404
Mailing Address - Street 1:2010 CALUMET AVE STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2913
Mailing Address - Country:US
Mailing Address - Phone:219-464-0404
Mailing Address - Fax:219-465-0333
Practice Address - Street 1:2010 CALUMET AVE STE A
Practice Address - Street 2:SUITE A
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2913
Practice Address - Country:US
Practice Address - Phone:219-464-0404
Practice Address - Fax:219-465-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60003643A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300001859Medicaid
2026664OtherPK