Provider Demographics
NPI:1790142255
Name:CAMBY LOW COST PHARMACY
Entity Type:Organization
Organization Name:CAMBY LOW COST PHARMACY
Other - Org Name:CAMBY LOW COST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUMAHFOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-548-8015
Mailing Address - Street 1:8411 WINDFALL LN STE 90
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8027
Mailing Address - Country:US
Mailing Address - Phone:317-548-8015
Mailing Address - Fax:317-830-8365
Practice Address - Street 1:8411 WINDFALL LN STE 90
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8027
Practice Address - Country:US
Practice Address - Phone:317-548-8015
Practice Address - Fax:317-830-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006559A333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157673OtherPK
IN201343280AMedicaid