FORT WAYNE PHARMACY (2838)    INSTITUTION (4)

Name Value
NAME FORT WAYNE PHARMACY
STATE INDIANA
STREET ADDR. 1 2121 LAKE AVE
CITY FORT WAYNE
ZIP 46805-5100
OFFICIAL VA NAME Fort Wayne Pharmacy
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME FORT WAYNE VAMC PHARMACY
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1427016369
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
HISTORY
  • STREET ADDR. 1 (CHANGED FROM):   2121 Lake Ave
    CITY (CHANGED FROM):   Fort Wayne
    STATE (CHANGED FROM):   INDIANA
    ZIP (CHANGED FROM):   46805-5100
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1427016369