Organization
PARKMOR DRUG INC.
Active
Other names
Park Home Medical Equipment
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY CHRISTOPHEL CPA,MBA (EXECUTIVE VICE PRESIDENT AND CFO)
(574) 533-2141
Entity
Organization
Contact information
Practice address
1501 S MAIN ST, GOSHEN, IN 46526-4719
(574) 533-0626
(574) 533-8948
Mailing address
1501 S MAIN ST, GOSHEN, IN 46526-4719
(574) 533-0626
(574) 533-8948
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097204002
ANTHEM
IN
Enumeration date
04/19/2006
Last updated
08/22/2020
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