Provider Demographics
NPI:1871084798
Name:SD&J LLC T A MADE-IN INDIANAPOLIS PHARMACY & MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:SD&J LLC T A MADE-IN INDIANAPOLIS PHARMACY & MEDICAL EQUIPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-696-6668
Mailing Address - Street 1:3350 N HIGH SCHOOL RD STE J
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-2050
Mailing Address - Country:US
Mailing Address - Phone:317-438-5236
Mailing Address - Fax:833-274-8632
Practice Address - Street 1:3350 N HIGH SCHOOL RD STE J
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-2050
Practice Address - Country:US
Practice Address - Phone:317-438-5236
Practice Address - Fax:833-274-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300017811Medicaid