Provider Demographics
NPI:1306251061
Name:UNIVERSITY COMMONS PHARMACY
Entity type:Organization
Organization Name:UNIVERSITY COMMONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAGHID
Authorized Official - Middle Name:
Authorized Official - Last Name:KADI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:574-340-8892
Mailing Address - Street 1:6301 UNIVERSITY COMMONS STE 500
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1478
Mailing Address - Country:US
Mailing Address - Phone:574-273-2000
Mailing Address - Fax:574-273-2004
Practice Address - Street 1:6301 UNIVERSITY COMMONS STE 500
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1478
Practice Address - Country:US
Practice Address - Phone:574-273-2000
Practice Address - Fax:574-273-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201239340Medicaid