Organization
CM SPECIALTY PHARMACY LLC
Active
Other names
CM Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF JACKSON (OWNER/PHARMACIST)
(317) 803-2069
Entity
Organization
Contact information
Practice address
5510 LAFAYETTE RD STE 260, INDIANAPOLIS, IN 46254-1691
(317) 803-2069
(317) 293-1836
Mailing address
6005 W 71ST ST, INDIANAPOLIS, IN 46278-1705
(317) 803-3436
(317) 803-3437
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
60006341A
IN
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141973
PK
—
Enumeration date
09/09/2013
Last updated
08/05/2016
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