MN RX, LLC SOUTHERN PHARMACY RX 272 (NPI# 1477013043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477013043 |
| Entity Type | Organization |
| Organization Name | MN RX, LLC SOUTHERN PHARMACY RX 272 |
| Practice Address |
1160 Joliet St Ste 204 Dyer IN 46311-2096 |
| Mailing Address |
2309 17th St Gulfport MS 39501-2904 |
| Practice Telephone | 2194400128 |
| Practice Fax Number | 2194407593 |
| Mailing Telephone | 2284004216 |
| Mailing Fax Number | 8006513566 |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-12-02 |
| Authorized Official Name | CHANDA MICHELLE JOHNSON (ADMINISTRATOR) |
| Authorized Official Telephone | 2106891022 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300030769 | 05 |
| Street Address |
1160 JOLIET ST STE 204 |
| City | DYER |
| State | IN |
| Zip Code | 46311-2096 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407338858 | Leena Yousef-diaz | Nurse Practitioner | 1100 Joliet Street Suite #201, Dyer, IN 46311 | 2018-09-02 |
| 1518476639 | Kor Speech Therapy, LLC | Speech-Language Pathologist | 219 Primrose Dr., Dyer, IN 46311 | 2017-09-20 |
| 1861921207 | Derrick Durrah | Counselor | 2615 James Drive, Dyer, IN 46311 | 2017-06-08 |
| 1073962189 | Maria Lule | Pharmacist | 805 Joliet Road, Dyer, IN 46311 | 2016-06-09 |
| 1780072157 | Mario Munoz | Skilled Nursing Facility | 515 Audrey Ct, Dyer, IN 46311 | 2015-01-07 |
| 1457772451 | Lisa Jennifer Mickelson | Registered Nurse | 600 Joliet St., Kahler Middle School, Dyer, IN 46311 | 2013-12-18 |
| 1285055285 | Tanya D Burk-willson | Registered Nurse | 14600 W 81st St., Bibich Elementary, Dyer, IN 46311 | 2013-12-18 |
| 1013338011 | Mary Beth Rinaldi | Registered Nurse | 1121 Harrison Ave, Protsman Elementary, Dyer, IN 46311 | 2013-12-18 |
| 1023448057 | Franciscan Alliance | General Acute Care Hospital | 24 Joliet Street, 3da, Dyer, IN 46311 | 2013-11-12 |
| 1508078239 | Fatima Jaffer Md Sc PC | Internal Medicine | Physicians Pavilion Suite 101, 24 East Joliet Street, Dyer, IN 46311 | 2007-05-04 |
| Find all providers in zip 46311 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073698023 | Walter Lagestee Incorporated | Pharmacy | 1218 Sheffield Ave, Dyer, IN 46311-1053 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457978439 | Engleking Rx Marengo LLC | Pharmacy | 125 W Old Short St, Marengo, IN 47140-3225 | 2020-06-25 |
| 1992320519 | Carrie Ann Dunnem | Pharmacy | 7355 Heritage Square Dr, Granger, IN 46530-5643 | 2020-06-09 |
| 1669095261 | Abi Westend Pharmacy | Pharmacy | 602 N High School Rd Ste A-1, Indianapolis, IN 46214-3694 | 2020-05-19 |
| 1982224911 | Apotheco Pharmacy Carmel LLC | Pharmacy | 12955 Old Meridian St Ste 102, Carmel, IN 46032-7193 | 2020-04-20 |
| 1922640077 | Indiana University Health Bloomington Inc | Pharmacy | 601 W 2nd St Ste 100, Bloomington, IN 47403-2317 | 2019-10-10 |
| 1831749399 | Julie Cindric | Pharmacy | 720 Adams St Ste 100, Carmel, IN 46032-7541 | 2019-09-17 |
| 1346898889 | Milan Pharmacy Inc | Pharmacy | 1935 N Capitol Ave Ste 120, Indianapolis, IN 46202-6403 | 2019-08-28 |
| 1093361867 | Cameron Medical Outreach, Inc | Pharmacy | 306 E Maumee St Ste 106, Angola, IN 46703-2038 | 2019-08-16 |
| 1962055186 | Custom Dosing East | Pharmacy | 4319 Franklin St, Michigan City, IN 46360-7806 | 2019-07-17 |
| 1659923894 | Genoa Healthcare, LLC | Pharmacy | 4022 Hohman Ave Ste 103, Hammond, IN 46327-1239 | 2019-07-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.