NPIMap

Organization Active NPI

GG II Indiana, LLC

Doing business as Needler's Fresh Market Pharmacy #928

  • Community/Retail Pharmacy
  • Pendleton, IN
National Provider Identifier
1083494348
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
GG II INDIANA, LLC
Doing business as
Needler's Fresh Market Pharmacy #928
Practice address
3015 W US Highway 36
Pendleton, IN 46064-9280
Phone
(765) 221-7100
NPI assigned
Oct 4, 2023
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joanna Bergum, PHARMD
Title
Director of Pharmacy
Phone
(317) 450-5335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

3015 W US Highway 36
Pendleton, IN 46064-9280

Mailing address

3015 W US Highway 36
Pendleton, IN 46064-9280
Phone (765) 221-7100

Other names 1

  • Needler's Fresh Market Pharmacy #928 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191113000250 IN Part B Supplier - Mass Immunization (Roster Biller Only) 4587925904 2 other NPIs on this enrollment
Practice locations: Indianapolis, IN

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
GG II Indiana LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1083494348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 W US HIGHWAY 36",
            "city": "PENDLETON",
            "state": "IN",
            "postal_code": "460649280",
            "telephone_number": "765-221-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 W US HIGHWAY 36",
            "city": "PENDLETON",
            "state": "IN",
            "postal_code": "460649280",
            "telephone_number": "765-221-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GG II INDIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "BERGUM",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "317-450-5335",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Needler's Fresh Market Pharmacy #928",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pendleton, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.