# THE SOUTH BEND CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The South Bend Clinic Pharmacy at Granger
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174187553
- **Authorized official:** ANDREA KRUPA (EXEC DIRECTORY OF PHARMACY)
- **Authorized official phone:** (574) 239-1461

## Contact information

- **Practice address:** 52500 FIR RD, GRANGER, IN 46530-8579
- **Practice address phone:** (574) 204-7260
- **Mailing address:** 211 N EDDY ST, SOUTH BEND, IN 46617-3096
- **Mailing address phone:** (574) 237-9295
- **Mailing address fax:** (574) 239-1554

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/01/2019
- **Last updated:** 11/26/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100300930 | — | IN |