Provider Demographics
NPI:1811952039
Name:PARKMOR DRUG INC.
Entity type:Organization
Organization Name:PARKMOR DRUG INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA,MBA
Authorized Official - Phone:574-533-2141
Mailing Address - Street 1:1501 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4719
Mailing Address - Country:US
Mailing Address - Phone:574-533-0626
Mailing Address - Fax:574-533-8948
Practice Address - Street 1:1501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4719
Practice Address - Country:US
Practice Address - Phone:574-533-0626
Practice Address - Fax:574-533-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097204002OtherANTHEM
IN0301090002Medicare ID - Type Unspecified