Prairestone Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60006165A Issued in IN

Legal business name

PRAIRESTONE PHARMACY LLC

Practice address

9320 Priority Way West Dr
Indianapolis, IN 46240-1468

Phone

(317) 573-0045

Fax

(317) 573-0206

NPI assigned

Sep 12, 2008

Organization subpart

No

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

Authorized official

Name

Matt Middendorf

Title

Chief Financial Office

Phone

(317) 569-8234

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Dailymed Pharmacy Doing business as

Tax ID family

Dailymed Pharmacy4 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.

• Prairiestone Pharmacy LLC

  • Pharmacist
  • Saint Paul, MN
  • NPI 1487733408
  NPD tax ID
• Prairiestone Pharmacy LLC

  • Pharmacist
  • Fort Lauderdale, FL
  • NPI 1508996497
  NPD tax ID
• Prairiestone Pharmacy LLC

  • Pharmacist
  • Eden Prairie, MN
  • NPI 1952431884
  NPD tax ID

Locations

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300147200000",
    "number": "1235388356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9830",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841099830",
            "telephone_number": "877-540-4748",
            "fax_number": "801-716-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9320 PRIORITY WAY WEST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401468",
            "telephone_number": "317-573-0045",
            "fax_number": "317-573-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRESTONE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-12",
        "last_updated": "2011-03-15",
        "status": "A",
        "authorized_official_last_name": "MIDDENDORF",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICE",
        "authorized_official_telephone_number": "317-569-8234"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006165A",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2878186",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1562378",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dailymed Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kamnesh R Pradhan, MD
• Rosemarie D Prado
• Kelsey Praeger
• Kathleen A Prag, M.D.
• Nathan Prahlow, M.D.
• Jon W Prairie, NP
• Chintan Prajapati, MD
• Sumi Prakash, M.D.
• Anna Jo Prall, DO
• Richard Thomas Prall, MD

• Community/Retail Pharmacy in Indianapolis, IN
• Providers in Indianapolis, 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 Mar 15, 2011; 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.