# LIFESPAN PHARMACY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Skilled Care of Indiana LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093968448
- **Authorized official:** KATHY L HEADLEY (CHAIRPERSON OF THE BOARD)
- **Authorized official phone:** (812) 961-2326

## Contact information

- **Practice address:** 9900 WESTPOINT DRIVE, SUITE 100, INDIANAPOLIS, IN 46256-3358
- **Practice address phone:** (317) 841-0388
- **Practice address fax:** (317) 841-0733
- **Mailing address:** 2749 EAST COVENANTER DRIVE, BLOOMINGTON, IN 47401-5454
- **Mailing address phone:** (812) 961-2326
- **Mailing address fax:** (317) 841-0733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 600061169B | IN | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/29/2008
- **Last updated:** 02/16/2023

## 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 |