Provider Demographics
NPI:1861960353
Name:INDIANA PHARMACY ALLIANCE
Entity type:Organization
Organization Name:INDIANA PHARMACY ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:219-296-9510
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0637
Mailing Address - Country:US
Mailing Address - Phone:219-987-3330
Mailing Address - Fax:219-987-3331
Practice Address - Street 1:325A N HALLECK ST
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-8670
Practice Address - Country:US
Practice Address - Phone:574-286-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy