NPIMap

Organization Active NPI

Indiana University Health, Inc

Doing business as South Retail Pharmacy

  • Community/Retail Pharmacy
  • Indianapolis, IN
National Provider Identifier
1669622783
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006255A Issued in IN
Legal business name
INDIANA UNIVERSITY HEALTH, INC
Doing business as
South Retail Pharmacy
Practice address
8820 S. Meridian St
Suite 105
Indianapolis, IN 46217-6057
Phone
(317) 865-6833
Fax
(317) 865-6832
NPI assigned
Sep 25, 2008
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Ryan Kitchell
Title
Evp & Cfo
Phone
(317) 962-2380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 60006255A IN Primary

Addresses

Primary practice location

8820 S. Meridian St
Suite 105
Indianapolis, IN 46217-6057

Mailing address

1776 N Meridian St Ste 100a
Retail Pharmacy Admin
Indianapolis, IN 46202-1468
Phone (317) 962-1522

Other identifiers 2

IdentifierTypeStateIssuer
200063700MedicaidIN
60006255AOtherINSTATE

Other names 1

  • South Retail Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130110000547 IN Part B Supplier - Mass Immunization (Roster Biller Only) 2365350675 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carmel, IN; Fishers, IN; Indianapolis, IN; Avon, IN

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1669622783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 N MERIDIAN ST STE 100A",
            "address_2": "RETAIL PHARMACY ADMIN",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021468",
            "telephone_number": "317-962-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8820 S. MERIDIAN ST",
            "address_2": "SUITE 105",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462176057",
            "telephone_number": "317-865-6833",
            "fax_number": "317-865-6832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-25",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KITCHELL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "317-962-2380"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006255A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200063700",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "60006255A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Retail Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.