Provider Demographics
NPI:1558306779
Name:HTC PHARMACY INC
Entity Type:Organization
Organization Name:HTC PHARMACY INC
Other - Org Name:HEMA SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-955-8770
Mailing Address - Street 1:1060 N CAPITOL AVE
Mailing Address - Street 2:SUITE E299
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1044
Mailing Address - Country:US
Mailing Address - Phone:317-955-8770
Mailing Address - Fax:317-955-6934
Practice Address - Street 1:1060 N CAPITOL AVE
Practice Address - Street 2:SUITE E299
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1044
Practice Address - Country:US
Practice Address - Phone:317-955-8770
Practice Address - Fax:317-955-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60004995A3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200153580Medicaid
2028266OtherPK