Organization
SHAKAMAK HEALTH INC
Active
Other names
Shakamak Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVER WOLF (PRESIDENT OF CORPORATION)
(812) 665-9760
Entity
Organization
Contact information
Practice address
346 E MAIN ST, JASONVILLE, IN 47438-1510
(812) 665-9760
(812) 665-9762
Mailing address
346 E MAIN ST, JASONVILLE, IN 47438-1510
(812) 665-9760
(812) 665-9762
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60006304A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201070090
—
IN
01
—
2134527
PK
—
Enumeration date
06/12/2012
Last updated
01/27/2020
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