Provider Demographics
NPI:1013985696
Name:INDIANA UNIVERSITY HEALTH, INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH, INC
Other - Org Name:NORTH RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-963-0213
Mailing Address - Street 1:1633 N CAPITOL AVE
Mailing Address - Street 2:SUITE 438
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1261
Mailing Address - Country:US
Mailing Address - Phone:317-967-9730
Mailing Address - Fax:317-963-5003
Practice Address - Street 1:11700 N MERIDIAN ST
Practice Address - Street 2:SUITE B106
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4656
Practice Address - Country:US
Practice Address - Phone:317-688-3035
Practice Address - Fax:317-688-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005915A3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1560350OtherOTHER ID NUMBER
IN200800220AMedicaid
INBC9535189OtherDEA
IN200800220AMedicaid