Provider Demographics
NPI:1861645061
Name:DAYS HEALTHY LIVING PHARMACY LLC
Entity Type:Organization
Organization Name:DAYS HEALTHY LIVING PHARMACY LLC
Other - Org Name:DAYS HEALTHY LIVING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-385-0072
Mailing Address - Street 1:1110 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9601
Mailing Address - Country:US
Mailing Address - Phone:317-984-2121
Mailing Address - Fax:317-984-3900
Practice Address - Street 1:1110 S PERU ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9601
Practice Address - Country:US
Practice Address - Phone:317-984-2121
Practice Address - Fax:317-984-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005626A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN209920510AMedicaid
1562429OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6249270001Medicare NSC