Provider Demographics
NPI:1770819872
Name:FLYWHEEL HEALTHCARE LLC
Entity Type:Organization
Organization Name:FLYWHEEL HEALTHCARE LLC
Other - Org Name:YOUNG AT HEART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:317-213-5117
Mailing Address - Street 1:PO BOX 3504
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-3504
Mailing Address - Country:US
Mailing Address - Phone:866-308-4990
Mailing Address - Fax:877-513-6937
Practice Address - Street 1:10330 N MERIDIAN ST STE 110
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46290-1024
Practice Address - Country:US
Practice Address - Phone:866-308-4990
Practice Address - Fax:877-513-6937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHNR.FO.60319761333600000X
MN2651973336C0004X
IN60006208A3336L0003X
OHNRP.022459650-123336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122500OtherPK
IN200962160AMedicaid
6595900001Medicare NSC