Organization
PROFESSIONAL PHARMACY
Active
Other names
DEXTER HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE FARNHAM RPH (CORP SECRETARY TREASURER)
(574) 722-5678
Entity
Organization
Contact information
Practice address
800 FULTON ST, LOGANSPORT, IN 46947-1577
(574) 722-5678
(574) 753-5597
Mailing address
800 FULTON ST, LOGANSPORT, IN 46947-1577
(574) 722-5678
(574) 753-5597
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
69000792A
IN
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100175590
—
IN
01
—
1518616
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/26/2005
Last updated
06/01/2012
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