Valparasio Professional Pharmacy, P.C.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60005539A Issued in IN

Legal business name

VALPARASIO PROFESSIONAL PHARMACY, P.C.

Doing business as

VALPARAISO PROFESSIONAL PHARMACY

Practice address

3540 Calumet Ave
Valparaiso, IN 46383-2246

Phone

(219) 462-1484

Fax

(219) 465-4199

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Elton L Vandertuin, RPH

Title

Owner

Phone

(219) 462-1484

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• VALPARAISO PROFESSIONAL PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Tax ID family

Valparaiso Professional Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Valparaiso Professional Pharmacy,P.C.

  • Community/Retail Pharmacy
  • Valparaiso, IN
  • NPI 1710420153
  NPD tax ID

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1184736027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 CALUMET AVE",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832246",
            "telephone_number": "219-462-1484",
            "fax_number": "219-465-4199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 CALUMET AVE",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832246",
            "telephone_number": "219-462-1484",
            "fax_number": "219-465-4199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALPARASIO PROFESSIONAL PHARMACY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "VANDERTUIN",
        "authorized_official_first_name": "ELTON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-462-1484",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "60006597",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IN",
            "license": "60006597",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60005539A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100300380",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2025017",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VALPARAISO PROFESSIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VALPARAISO PROFESSIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Community/Retail Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; 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.