Provider Demographics
NPI:1891199295
Name:ANDERSON HEALTHCARE INC
Entity Type:Organization
Organization Name:ANDERSON HEALTHCARE INC
Other - Org Name:SHIPSHEWANA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:260-768-4433
Mailing Address - Street 1:350 S VAN BUREN ST STE F
Mailing Address - Street 2:
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-9197
Mailing Address - Country:US
Mailing Address - Phone:260-768-4433
Mailing Address - Fax:260-768-4033
Practice Address - Street 1:350 S VAN BUREN ST STE F
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-9197
Practice Address - Country:US
Practice Address - Phone:260-768-4433
Practice Address - Fax:260-768-4033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006400B3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60006400BOtherINDIANA PHARMACY LICENSE