MEDICARE: MARC DAVID KRUEGER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26022195A	IN

General Provider Information

NPI Number	:	1124304068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC DAVID KRUEGER PHARMD

Provider Business Mailing Address
First Line	:	1146 IVY LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9050 E 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-2004
Country	:	US
Telephone Number	:	317-898-9293
Fax Number	:	317-895-1871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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