Provider Demographics
NPI:1770749194
Name:ACCUPAX LLC
Entity type:Organization
Organization Name:ACCUPAX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTRIEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-287-7345
Mailing Address - Street 1:8770 GUION RD
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3042
Mailing Address - Country:US
Mailing Address - Phone:317-829-5454
Mailing Address - Fax:317-829-0541
Practice Address - Street 1:8770 GUION RD
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3042
Practice Address - Country:US
Practice Address - Phone:800-978-0531
Practice Address - Fax:888-688-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006158A3336S0011X
WVMO05601183336S0011X
IL054.0167563336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200936340AMedicaid
1562417OtherNCPDP PROVIDER IDENTIFICATION NUMBER