Provider Demographics
NPI:1891389490
Name:NRS PHARMACIES OF INDIANA LLC
Entity Type:Organization
Organization Name:NRS PHARMACIES OF INDIANA LLC
Other - Org Name:MEDICENTER ALTERNATE CARE PHARMCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE AND ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-965-4700
Mailing Address - Street 1:132 W MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5816
Mailing Address - Country:US
Mailing Address - Phone:314-960-7300
Mailing Address - Fax:314-965-4706
Practice Address - Street 1:100 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-1118
Practice Address - Country:US
Practice Address - Phone:765-334-8331
Practice Address - Fax:765-334-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20119450Medicaid
IN6006693AOtherSTATE PHARMACY LICENSE NUMBER