Organization Name: | HEART CITY HEALTH CENTER PHARMACY |
NPI Number: | 1003802455 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EUGENIO EDWARDO VALDEZ (QUALIFYING PHARMACIST) |
Mailing Address: | 236 Simpson Ave Elkhart |
State: | IN US |
Postal Code: | 465164671 |
Phone Number: | 5749701441 |
Fax Number: | 5749701449 |
NPI Enumeration Date: | 09/21/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | 60005127A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |