Organization
SRC PHARMACY LLC
Active
Other names
RESIDENTIAL CRF
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON C ALLEN RPH (PHARMACIST)
(765) 825-6800
Entity
Organization
Contact information
Practice address
2600 WESTERN AVE, CONNERSVILLE, IN 47331-1803
(765) 825-6800
(765) 827-0011
Mailing address
2600 WESTERN AVE, CONNERSVILLE, IN 47331-1803
(765) 825-6800
(765) 827-0011
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200454050A
—
IN
Enumeration date
05/02/2006
Last updated
12/05/2019
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