Provider Demographics
NPI:1780151191
Name:EXTENDED PHARMACY 2 LLC
Entity type:Organization
Organization Name:EXTENDED PHARMACY 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:317-343-2056
Mailing Address - Street 1:6030 W 62ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2909
Mailing Address - Country:US
Mailing Address - Phone:317-343-2056
Mailing Address - Fax:877-361-5651
Practice Address - Street 1:6030 W 62ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2909
Practice Address - Country:US
Practice Address - Phone:317-343-2056
Practice Address - Fax:877-361-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy