FORT WAYNE MEDICAL ONCOLOGY & HEMAT
4402 E State Blvd
Fort Wayne, IN 46815
260-969-7846
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 3336C0002X | Suppliers - Pharmacy - Clinic Pharmacy | IN | 60005894A |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
200544860A | IN | MEDICAID | |
NCPDP PROVIDER IDENTIFICATION NUMBER | 1560247 | OTHER |