The South Bend Clinic Pharmacy

Primary specialty

PharmacistTaxonomy code 183500000X

License

60004874A Issued in IN

Legal business name

THE SOUTH BEND CLINIC PHARMACY

Practice address

211 N Eddy St
South Bend, IN 46617

Phone

(574) 237-9295

Fax

(574) 239-1554

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Andrea Krupa

Title

Exec Director Pharmacy

Phone

(574) 239-1461

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Ironwood Medical Group9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

• Family Care Associates

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1225019219
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • Mishawaka, IN
  • NPI 1124791587
  NPD tax ID
• The South Bend Clinic LLC

  • Clinic Pharmacy
  • Granger, IN
  • NPI 1174187553
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • South Bend, IN
  • NPI 1538832910
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • South Bend, IN
  • NPI 1891468278
  NPD tax ID
• The South Bend Clinic LLP

  • Clinical Medical Laboratory
  • South Bend, IN
  • NPI 1528659216
  NPD tax ID
• The South Bend Clinic LLP

  • Clinic/Center
  • South Bend, IN
  • NPI 1538257167
  NPD tax ID
• The South Bend Clinic, LLC

  • Anesthesiology Physician
  • South Bend, IN
  • NPI 1487307492
  NPD tax ID

Locations

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1144357328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172808",
            "telephone_number": "574-237-9295",
            "fax_number": "574-239-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46617",
            "telephone_number": "574-237-9295",
            "fax_number": "574-239-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTH BEND CLINIC PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "KRUPA",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "EXEC DIRECTOR PHARMACY",
        "authorized_official_telephone_number": "574-239-1461",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "60004874A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP OR NCPDP",
            "identifier": "1507221",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100300930",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The South Bend Clinic LLC
• The South Bend Clinic LLC
• The South Bend Clinic LLC
• The South Bend Clinic LLP
• The South Bend Clinic LLP
• The South Bend Clinic, LLC
• The Venus Home Care-Indiana LLC
• Michael Joseph Theall, LMHC
• Kristine A. Thelen, LCSW
• Therapeutic Indulgence

• Pharmacist in South Bend, IN
• Providers in South Bend, IN by specialty
• Pharmacist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.