Provider Demographics
NPI:1932419314
Name:CANCER CARE PARTNERS LLC
Entity Type:Organization
Organization Name:CANCER CARE PARTNERS LLC
Other - Org Name:CANCER CARE PARTNERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-364-2651
Mailing Address - Street 1:301 E DAY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3455
Mailing Address - Country:US
Mailing Address - Phone:574-204-7239
Mailing Address - Fax:574-204-7231
Practice Address - Street 1:301 E DAY RD STE 300
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3455
Practice Address - Country:US
Practice Address - Phone:574-204-7239
Practice Address - Fax:574-204-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006239A3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1563130OtherNCPDP PROVIDER IDENTIFICATION NUMBER