Organization
HOLLONS PANORAMA PHARMACY INC
Active
Other names
HOLLONS PANORMA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRE BUTLER (MANAGER)
(765) 644-8851
Entity
Organization
Contact information
Practice address
2517 E 10TH ST, ANDERSON, IN 46012-4409
(765) 644-8851
(336) 861-0173
Mailing address
2517 E 10TH ST, ANDERSON, IN 46012-4409
(765) 644-8851
(336) 861-0173
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60003770
IN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100277250
—
IN
01
—
1505392
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/27/2005
Last updated
08/25/2010
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