Organization
SKICO INC
Active
Other names
MILLERS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY RYAN CRAWFORD PHARMD (PHARMACY MANAGER)
(260) 463-7464
Entity
Organization
Contact information
Practice address
420 S DETROIT ST, LAGRANGE, IN 46761-2310
(260) 463-7464
(260) 463-8150
Mailing address
420 S DETROIT ST, LAGRANGE, IN 46761-2310
(260) 463-7464
(260) 463-8150
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60005484A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200259580A
—
IN
01
—
2024261
PK
—
Enumeration date
11/07/2006
Last updated
05/22/2024
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