Provider Demographics
NPI:1902695802
Name:ASPIRE INDIANA PHARMACY, LLC
Entity type:Organization
Organization Name:ASPIRE INDIANA PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-587-0505
Mailing Address - Street 1:9615 E 148TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4371
Mailing Address - Country:US
Mailing Address - Phone:317-268-5319
Mailing Address - Fax:317-449-5959
Practice Address - Street 1:17840 CUMBERLAND RD RM 300
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5409
Practice Address - Country:US
Practice Address - Phone:317-268-5319
Practice Address - Fax:317-449-5959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRE INDIANA HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-06
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy