Provider Demographics
NPI:1477161909
Name:DAMIEN PHARMACY, LLC
Entity type:Organization
Organization Name:DAMIEN PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-632-0123
Mailing Address - Street 1:26 N ARSENAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3808
Mailing Address - Country:US
Mailing Address - Phone:317-981-1989
Mailing Address - Fax:317-981-1900
Practice Address - Street 1:26 N ARSENAL AVE STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3808
Practice Address - Country:US
Practice Address - Phone:317-981-1989
Practice Address - Fax:317-981-1900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DAMIEN CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-21
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3000043175Medicaid