Provider Demographics
NPI:1700413721
Name:DAMAR PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:DAMAR PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, HSPP, CSAYC
Authorized Official - Phone:317-455-7106
Mailing Address - Street 1:6067 DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-9606
Mailing Address - Country:US
Mailing Address - Phone:317-856-5201
Mailing Address - Fax:317-856-2333
Practice Address - Street 1:5715 DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9561
Practice Address - Country:US
Practice Address - Phone:317-856-5201
Practice Address - Fax:317-856-2333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAMAR SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty