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Organization
LIFESPAN PHARMACY LLC
Active
Organization
LIFESPAN PHARMACY LLC
Active
Other names
Skilled Care of Indiana LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY L HEADLEY (CHAIRPERSON OF THE BOARD)
(812) 961-2326
Entity
Organization
Contact information
Practice address
9900 WESTPOINT DRIVE, SUITE 100, INDIANAPOLIS, IN 46256-3358
(317) 841-0388
(317) 841-0733
Mailing address
2749 EAST COVENANTER DRIVE, BLOOMINGTON, IN 47401-5454
(812) 961-2326
(317) 841-0733
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336I0012X
Institutional Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
600061169B
IN
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200925240
—
IN
05
—
200925240A
—
IN
01
—
2117622
PK
—
01
—
60006848A
PHARMACY LICENSE
IN
01
—
60006848B
CSR-PHARMACY
IN
Enumeration date
10/29/2008
Last updated
02/16/2023
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