Provider Demographics
NPI:1437183456
Name:MED-A-CARE LLC
Entity Type:Organization
Organization Name:MED-A-CARE LLC
Other - Org Name:MEDPHARM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KABOUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-232-2086
Mailing Address - Street 1:2723 S 7TH ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3584
Mailing Address - Country:US
Mailing Address - Phone:812-232-2086
Mailing Address - Fax:812-234-9103
Practice Address - Street 1:2723 S 7TH ST
Practice Address - Street 2:SUITE N
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3584
Practice Address - Country:US
Practice Address - Phone:812-232-2086
Practice Address - Fax:812-234-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IN60005931A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2025365OtherPK
IN200806110AMedicaid
IN200806110AMedicaid