Organization
WITHAM MEMORIAL HOSPITAL
Active
Other names
Pavilion Pointe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL SHAY (PHARMACY MANAGER)
(765) 483-3900
Entity
Organization
Contact information
Practice address
2705 N LEBANON ST STE 100, LEBANON, IN 46052-8621
(765) 483-3900
(765) 483-3909
Mailing address
2705 N LEBANON ST, STE 100, LEBANON, IN 46052-8621
(765) 483-3900
(765) 483-3909
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60006428A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147853
PK
—
05
—
300067193
—
IN
Enumeration date
02/19/2015
Last updated
03/21/2023
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