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Organization
STATE OF INDIANA AUDITOR OF STATE
Active
Organization
STATE OF INDIANA AUDITOR OF STATE
Active
Other names
NeuroDiagnostic Institute Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA L RUTHERFORD (CONTROLLER, INDIANA FAMILY & SOCIAL)
(317) 232-7862
Entity
Organization
Contact information
Practice address
5435 EAST 16TH STREET, INDIANAPOLIS, IN 46218-5101
(317) 941-4000
(317) 941-4378
Mailing address
5435 EAST 16TH STREET, INDIANAPOLIS, IN 46218-5101
(317) 941-4000
(317) 941-4378
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
60001313A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100273130A
—
IN
01
—
2024895
PK
—
Enumeration date
07/30/2006
Last updated
01/09/2019
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