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Individual provider · Community/Retail Pharmacy · Indianapolis, IN

NPI
1427931096
Type
Individual (Type 1)
Primary specialty
Community/Retail Pharmacy (Pharmacy)
Specialty group
Suppliers
Taxonomy code
3336C0003X
License number
26031170A (IN)
Sex
Male
Sole proprietor
Yes
Enumerated
2025-07-30
Last updated
2025-07-30
Practice location
4401 E 10th St
Indianapolis, IN 46201-2744
(317) 460-9647

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