Organization
INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC
Active
Other names
IU Health Pavilion Community Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LUTHER (CFO)
(765) 751-2795
Entity
Organization
Contact information
Practice address
2401 W UNIVERSITY AVE # OMP1635, MUNCIE, IN 47303-3428
(765) 747-8461
(765) 747-8472
Mailing address
1633 N CAPITOL AVE, SUITE 438, INDIANAPOLIS, IN 46202-1261
(317) 963-9730
(317) 963-5003
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60004092A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100295190
—
IN
01
—
1528732
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/12/2006
Last updated
08/19/2016
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