Organization
PRAIRESTONE PHARMACY LLC
Active
Other names
Dailymed Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MIDDENDORF (CHIEF FINANCIAL OFFICE)
(317) 569-8234
Entity
Organization
Contact information
Practice address
9320 PRIORITY WAY WEST DR, INDIANAPOLIS, IN 46240-1468
(317) 573-0045
(317) 573-0206
Mailing address
PO BOX 9830, SALT LAKE CITY, UT 84109-9830
(877) 540-4748
(801) 716-4872
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60006165A
IN
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1562378
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
2878186
—
OH
Enumeration date
09/12/2008
Last updated
03/15/2011
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