SRC Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

SRC PHARMACY LLC

Practice address

2600 Western Ave
Connersville, IN 47331-1803

Phone

(765) 825-6800

Fax

(765) 827-0011

NPI assigned

May 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jason C Allen, RPH

Title

Pharmacist

Phone

(765) 825-6800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• RESIDENTIAL CRF Other name

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575504000000",
    "number": "1740248616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 WESTERN AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473311803",
            "telephone_number": "765-825-6800",
            "fax_number": "765-827-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 WESTERN AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473311803",
            "telephone_number": "765-825-6800",
            "fax_number": "765-827-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRC PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2019-12-05",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "765-825-6800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200454050A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RESIDENTIAL CRF",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "RESIDENTIAL CRF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Long Term Care Pharmacy in Connersville, IN
• Providers in Connersville, IN by specialty
• Long Term Care Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2019; 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.