# SRC PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RESIDENTIAL CRF
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740248616
- **Authorized official:** MR. JASON C ALLEN RPH (PHARMACIST)
- **Authorized official phone:** (765) 825-6800

## Contact information

- **Practice address:** 2600 WESTERN AVE, CONNERSVILLE, IN 47331-1803
- **Practice address phone:** (765) 825-6800
- **Practice address fax:** (765) 827-0011
- **Mailing address:** 2600 WESTERN AVE, CONNERSVILLE, IN 47331-1803
- **Mailing address phone:** (765) 825-6800
- **Mailing address fax:** (765) 827-0011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 12/05/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200454050A | — | IN |