National Provider Identifier Database

FORT WAYNE MEDICAL ONCOLOGY HEMAT
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

FORT WAYNE MEDICAL ONCOLOGY & HEMAT
4402 E STATE BLVD
FORT WAYNE, IN46815-6917
Phone: 260-969-7846
Fax: 260-483-1734
Website:
Specialty Taxonomy Code
* Clinic Pharmacy 3336C0002X

* Indicates primary specialty

NPI Profile & details for FORT WAYNE MEDICAL ONCOLOGY & HEMAT

NPI Number 1215066949
Legal business name
LBN
FORT WAYNE MEDICAL ONCOLOGY & HEMAT
Authorized official TRACY MARAVILLA - (PHARMACY DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 03/06/2007
Last updated 05/03/2010 - About 16 years ago
Sole proprietor1 Not specified
Identifiers
  • IN License #: 60005894A
  • IN Medicaid: 200544860A
  • Other: 1560247 NCPDP PROVIDER IDENTIFICATION NUMBER

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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