Provider Demographics
NPI:1568457901
Name:PHILLIPS DRUGS INC
Entity Type:Organization
Organization Name:PHILLIPS DRUGS INC
Other - Org Name:PHILLIPS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:765-966-5544
Mailing Address - Street 1:631 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4309
Mailing Address - Country:US
Mailing Address - Phone:765-966-5544
Mailing Address - Fax:317-966-1497
Practice Address - Street 1:631 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4309
Practice Address - Country:US
Practice Address - Phone:765-966-5544
Practice Address - Fax:317-966-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
IN60001238A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100302690Medicaid
2023984OtherPK
2023984OtherPK