Provider Demographics
NPI:1588015010
Name:CORDANT PHARMACY INDIANA LLC
Entity Type:Organization
Organization Name:CORDANT PHARMACY INDIANA LLC
Other - Org Name:CORDANT PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-314-0146
Mailing Address - Street 1:12015 E 46TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3116
Mailing Address - Country:US
Mailing Address - Phone:855-895-8090
Mailing Address - Fax:303-371-0583
Practice Address - Street 1:5250 E US HIGHWAY 36 STE 660
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7996
Practice Address - Country:US
Practice Address - Phone:765-293-9211
Practice Address - Fax:317-735-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60006573A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160926OtherPK