NPIMap

Organization Active NPI

Indiana University Health, Inc.

Doing business as East Retail Pharmacy

  • Community/Retail Pharmacy
  • Indianapolis, IN
National Provider Identifier
1114177235
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006253A Issued in IN
Legal business name
INDIANA UNIVERSITY HEALTH, INC.
Doing business as
East Retail Pharmacy
Practice address
9650 E Washington St
Indianapolis, IN 46229-3032
Phone
(317) 890-5527
Fax
(317) 890-5675
NPI assigned
Sep 25, 2008
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Ryan Kitchell
Title
Evp & Cfo
Phone
(317) 962-2380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 60006253A IN Primary

Addresses

Primary practice location

9650 E Washington St
Indianapolis, IN 46229-3032

Mailing address

1776 N Meridian St
Ste 100a Retail Pharmacy Admin
Indianapolis, IN 46202-1468
Phone (317) 963-9730

Other identifiers 2

IdentifierTypeStateIssuer
60006253AOtherINSTATE
200003770MedicaidIN

Other names 1

  • East Retail Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130110000547 IN Part B Supplier - Mass Immunization (Roster Biller Only) 2365350675 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carmel, IN; Fishers, IN; Indianapolis, IN; Avon, IN

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Member of 4

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1633 N Capitol Ave
Ste 438
Indianapolis, IN 46202

1776 N Meridian St
Ste 100A
Indianapolis, IN 46202
Phone (317) 962-1746

950 N Meridian St
Ste 200
Indianapolis, IN 46204

NPI Registry JSON

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1114177235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 N MERIDIAN ST",
            "address_2": "STE 100A RETAIL PHARMACY ADMIN",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021468",
            "telephone_number": "317-963-9730",
            "fax_number": "317-963-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9650 E WASHINGTON ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462293032",
            "telephone_number": "317-890-5527",
            "fax_number": "317-890-5675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-25",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KITCHELL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "317-962-2380"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006253A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "60006253A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200003770",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Retail Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.