Provider Demographics
NPI:1518914043
Name:NOLTE'S PHARMACY INC
Entity Type:Organization
Organization Name:NOLTE'S PHARMACY INC
Other - Org Name:NOLTE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:WALSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-934-2414
Mailing Address - Street 1:1 E GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006
Mailing Address - Country:US
Mailing Address - Phone:812-934-2414
Mailing Address - Fax:812-934-3909
Practice Address - Street 1:1 E GEORGE ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006
Practice Address - Country:US
Practice Address - Phone:812-934-2414
Practice Address - Fax:812-934-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
60001823A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100300690AMedicaid
IN100300690AMedicaid
0184400001Medicare NSC