Organization
MADISON APOTHECARY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIK R GROVE PHARM.D. (PRESIDENT)
(812) 265-4621
Entity
Organization
Contact information
Practice address
835 W MAIN ST, MADISON, IN 47250-3131
(812) 265-4621
(812) 273-6666
Mailing address
835 W MAIN ST, MADISON, IN 47250-3131
(812) 265-4621
(812) 273-6666
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
60006043A
IN
332BX2000X
Oxygen Equipment & Supplies (DME)
60006043A
IN
3336C0003X
Community/Retail Pharmacy
Primary
60006043A
IN
3336C0003X
Community/Retail Pharmacy
IN1246
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200847540A
—
IN
Enumeration date
11/13/2006
Last updated
09/25/2007
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