Provider Demographics
NPI:1982197463
Name:360 PHARMACY CARE LLC
Entity Type:Organization
Organization Name:360 PHARMACY CARE LLC
Other - Org Name:360 PHARMACY CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-669-1093
Mailing Address - Street 1:2441 PRODUCTION DR STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4929
Mailing Address - Country:US
Mailing Address - Phone:317-669-1093
Mailing Address - Fax:317-836-0305
Practice Address - Street 1:2441 PRODUCTION DR STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4929
Practice Address - Country:US
Practice Address - Phone:317-669-1093
Practice Address - Fax:317-836-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60006670A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177743OtherPK