National Provider Identifier Database

THE SOUTH BEND CLINIC LLC
Clinic Pharmacy

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.


Contact Information

THE SOUTH BEND CLINIC LLC
52500 FIR RD
GRANGER, IN46530-8579
Phone: 574-204-7260
Fax:
Website:
Specialty Taxonomy Code
* Clinic Pharmacy 3336C0002X

* Indicates primary specialty

NPI Profile & details for THE SOUTH BEND CLINIC LLC

NPI Number 1174187553
Legal business name
LBN
THE SOUTH BEND CLINIC LLC
Authorized official ANDREA KRUPA - (EXEC DIRECTORY OF PHARMACY)
Entity Organization
Organization subpart No
Enumeration date 05/01/2019
Last updated 11/26/2024 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • IN Medicaid: 100300930

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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