Provider Demographics
NPI:1629145321
Name:DAYWALT PHARMACIES, INC
Entity Type:Organization
Organization Name:DAYWALT PHARMACIES, INC
Other - Org Name:DAYWALT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAYWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-563-4155
Mailing Address - Street 1:948 N CASS ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1044
Mailing Address - Country:US
Mailing Address - Phone:260-563-4155
Mailing Address - Fax:260-563-4654
Practice Address - Street 1:948 N CASS ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1044
Practice Address - Country:US
Practice Address - Phone:260-563-4155
Practice Address - Fax:260-563-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005204A332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100302390AMedicaid
1505986OtherNCPDP
IN0560410001Medicare NSC