Organization
PENDLETON LOWCOST PRESCRIPTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES CLEVENGER (PRESIDENT)
(765) 778-1851
Entity
Organization
Contact information
Practice address
777 E WATER ST, PENDLETON, IN 46064-9317
(765) 778-1851
(765) 778-7181
Mailing address
777 E WATER ST, PENDLETON, IN 46064-9317
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
333600000X
Pharmacy
60004826A
IN
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1532109
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/31/2006
Last updated
09/11/2025
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