NPIMap

Organization Active NPI

Panacea Pharmacy Inc

  • Community/Retail Pharmacy
  • Bloomington, IN
National Provider Identifier
1265823926
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006429A Issued in IN
Legal business name
PANACEA PHARMACY INC
Practice address
2424 S Walnut St
Bloomington, IN 47401-7730
Phone
(812) 287-8884
Fax
(812) 287-8921
NPI assigned
Feb 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Authorized official

Name
Joshua AndersonNPI 1346941093
Title
President
Phone
(812) 276-5782

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 60006429A IN Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

2424 S Walnut St
Bloomington, IN 47401-7730

Mailing address

PO Box 366
Bedford, IN 47421-0366
Phone (812) 276-5782

Other identifiers 2

IdentifierTypeStateIssuer
201282000AMedicaidIN
2150437OtherPK

Other names 1

  • Panacea Pharmacy Inc. Doing business as

National Provider Directory

National Provider Directory

Locations

2424 S Walnut St
Bloomington, IN 47401
Phone (812) 287-8884

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1424044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1265823926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474210366",
            "telephone_number": "812-276-5782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S WALNUT ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474017730",
            "telephone_number": "812-287-8884",
            "fax_number": "812-287-8921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANACEA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-16",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-276-5782"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006429A",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201282000A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2150437",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panacea Pharmacy Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.