| Organization Name: | CARDINAL HEALTH 414, LLC |
| NPI Number: | 1508272691 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAUL GOTTI (VP OPERATIONS) |
| Mailing Address: | 1100 Airport N, Suite D Ft. Wayne |
| State: | IN US |
| Postal Code: | 46825 |
| Phone Number: | 2604891173 |
| Fax Number: | |
| NPI Enumeration Date: | 07/09/2014 |
| NPI Last Update Date: | 07/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336N0007X |
| License Number: | 60006375A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Nuclear Pharmacy |
| Taxonomy Definition: | A pharmacy dedicated to the compounding and dispensing of radioactive materials for use in nuclear imaging and nuclear medical procedures. |