Provider Demographics
NPI:1801972260
Name:CARDINAL COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:CARDINAL COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HINSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:765-529-5808
Mailing Address - Street 1:499 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4849
Mailing Address - Country:US
Mailing Address - Phone:765-529-5808
Mailing Address - Fax:765-521-4962
Practice Address - Street 1:499 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4849
Practice Address - Country:US
Practice Address - Phone:765-529-5808
Practice Address - Fax:765-521-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005873A332B00000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5347290001Medicare ID - Type Unspecified