Provider Demographics
NPI:1265880389
Name:PURDUE GMP CENTER
Entity type:Organization
Organization Name:PURDUE GMP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRODUCTION COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-464-8414
Mailing Address - Street 1:3070 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1075
Mailing Address - Country:US
Mailing Address - Phone:765-464-8414
Mailing Address - Fax:765-464-8408
Practice Address - Street 1:3070 KENT AVE
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1075
Practice Address - Country:US
Practice Address - Phone:765-464-8414
Practice Address - Fax:765-464-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332900000X332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site