Provider Demographics
NPI:1851816763
Name:QUIK SCRIPTS OF NORTHWEST INDIANA LLC
Entity Type:Organization
Organization Name:QUIK SCRIPTS OF NORTHWEST INDIANA LLC
Other - Org Name:QUIK SCRIPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:219-671-7371
Mailing Address - Street 1:10865 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8513
Mailing Address - Country:US
Mailing Address - Phone:219-924-9540
Mailing Address - Fax:219-924-9535
Practice Address - Street 1:10865 MAPLE LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8513
Practice Address - Country:US
Practice Address - Phone:219-365-9701
Practice Address - Fax:219-365-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201258160AMedicaid