Provider Demographics
NPI:1922445824
Name:DEMOTTE DRUGS INC
Entity Type:Organization
Organization Name:DEMOTTE DRUGS INC
Other - Org Name:STURDY HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF TECHNOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-987-6468
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0662
Mailing Address - Country:US
Mailing Address - Phone:219-987-6468
Mailing Address - Fax:219-987-7226
Practice Address - Street 1:1001 STURDY RD
Practice Address - Street 2:STE 201
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4126
Practice Address - Country:US
Practice Address - Phone:219-462-0047
Practice Address - Fax:219-462-0086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEMOTTE DRUGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-31
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1700145420306332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201182440AMedicaid