Shakamak Health Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60006304A Issued in IN

Legal business name

SHAKAMAK HEALTH INC

Practice address

346 E Main St
Jasonville, IN 47438-1510

Phone

(812) 665-9760

Fax

(812) 665-9762

NPI assigned

Jun 12, 2012

Organization subpart

No

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

Authorized official

Name

Traver WolfNPI 1235732934

Title

President of Corporation

Phone

(812) 665-9760

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Shakamak Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in IN2 enrollments

Enrollment records 2

Practitioners 1

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

• Traver Wolf, PHARMACIST

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Jasonville, IN
  • NPI 1235732934
  NPD Authorized official

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1477815868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 E MAIN ST",
            "city": "JASONVILLE",
            "state": "IN",
            "postal_code": "474381510",
            "telephone_number": "812-665-9760",
            "fax_number": "812-665-9762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 E MAIN ST",
            "city": "JASONVILLE",
            "state": "IN",
            "postal_code": "474381510",
            "telephone_number": "812-665-9760",
            "fax_number": "812-665-9762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAKAMAK HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "TRAVER",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "812-665-9760"
    },
    "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": "60006304A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201070090",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2134527",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shakamak Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• MSD of Shakamak
• Ruth A Quinlan, QMRP
• Lisa Leann Racine, OTR
• Shakamak Family Dentistry, LLC
• Shakamak Health Inc
• Shakamak Medical Center, Inc.
• Shakamak Rehab Inc
• Southwestern Emerg. Med. Serv. Inc.
• Morgan Rene May Sparks, MT-BC
• Summit Dermatology, Inc.

• All providers in Jasonville, IN
• Community/Retail Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.