Provider Demographics
NPI:1720229792
Name:INDIANA UNIVERSITY HEALTH LAPORTE HOSPITAL, INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH LAPORTE HOSPITAL, INC
Other - Org Name:LA PORTE REGIONAL HEALTH SYSTEM, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LOEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, RPH, BS, BA
Authorized Official - Phone:219-326-2591
Mailing Address - Street 1:1007 LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3201
Mailing Address - Country:US
Mailing Address - Phone:219-326-2591
Mailing Address - Fax:219-326-2578
Practice Address - Street 1:1007 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3201
Practice Address - Country:US
Practice Address - Phone:219-326-2591
Practice Address - Fax:219-326-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60002029A3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1516105OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IN1516105OtherNCPDP