Provider Demographics
NPI:1700385663
Name:GGII INDIANA, LLC
Entity Type:Organization
Organization Name:GGII INDIANA, LLC
Other - Org Name:NEEDLER'S FRESH MARKET PHARMACY #932
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-450-5335
Mailing Address - Street 1:2250 TEAL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2218
Mailing Address - Country:US
Mailing Address - Phone:765-637-7455
Mailing Address - Fax:765-607-1561
Practice Address - Street 1:2250 TEAL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2218
Practice Address - Country:US
Practice Address - Phone:765-637-7455
Practice Address - Fax:765-607-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy