Provider Demographics
NPI:1952951162
Name:LOCAL HEALTH SPECIALTY INC.
Entity Type:Organization
Organization Name:LOCAL HEALTH SPECIALTY INC.
Other - Org Name:WILLOWBROOK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING/CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:573-885-0885
Mailing Address - Street 1:330 N. FRANKLIN
Mailing Address - Street 2:PO BOX 528
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453
Mailing Address - Country:US
Mailing Address - Phone:573-885-0885
Mailing Address - Fax:573-677-0567
Practice Address - Street 1:720 ADAMS ST. STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7541
Practice Address - Country:US
Practice Address - Phone:463-333-7100
Practice Address - Fax:463-333-7101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOCAL HEALTH SPECIALTY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-19
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300031413Medicaid