Provider Demographics
NPI:1447122262
Name:PURDUE UNIVERSITY
Entity type:Organization
Organization Name:PURDUE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALVO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MPH
Authorized Official - Phone:317-880-5406
Mailing Address - Street 1:640 ESKENAZI AVE, FIFTH THIRD BANK FOB
Mailing Address - Street 2:PURDUE UNIVERSITY DEPT PHARMACY PRACTICE, 3RD FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3737 WALDEMERE AVE STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-7234
Practice Address - Country:US
Practice Address - Phone:317-880-5406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy