Provider Demographics
NPI:1356610299
Name:ALIVIO PHARMACY, LLC
Entity type:Organization
Organization Name:ALIVIO PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-354-8160
Mailing Address - Street 1:2060 N SHADELAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1764
Mailing Address - Country:US
Mailing Address - Phone:317-354-8160
Mailing Address - Fax:317-354-8162
Practice Address - Street 1:2060 N SHADELAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1764
Practice Address - Country:US
Practice Address - Phone:317-354-8160
Practice Address - Fax:317-354-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.019801333600000X
IN60006279A3336C0004X
3336M0002X
FLPH301793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133084OtherPK
IN201193150AMedicaid
IN30020380Medicaid