Provider Demographics
NPI:1518015874
Name:NORTH MANCHESTER PHARMACIES
Entity Type:Organization
Organization Name:NORTH MANCHESTER PHARMACIES
Other - Org Name:KEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-982-4224
Mailing Address - Street 1:1202 STATE ROAD 114 W
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-1946
Mailing Address - Country:US
Mailing Address - Phone:260-982-4224
Mailing Address - Fax:260-982-2853
Practice Address - Street 1:1202 STATE ROAD 114 W
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1946
Practice Address - Country:US
Practice Address - Phone:260-982-4224
Practice Address - Fax:260-982-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014537A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0801920002Medicare ID - Type Unspecified