Provider Demographics
NPI:1922640077
Name:INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
Other - Org Name:IU HEALTH BLOOMINGTON RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-353-5819
Mailing Address - Street 1:390 AIRTECH PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7456
Mailing Address - Country:US
Mailing Address - Phone:317-963-9730
Mailing Address - Fax:317-963-5003
Practice Address - Street 1:2651 E DISCOVERY PKWY STE A2032
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-353-9860
Practice Address - Fax:812-353-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy