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NPI Code Detail

MEDICARE: CHRISTOPHER EDELEN

MEDICARE: CHRISTOPHER EDELEN
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
1183500000XPharmacist26023225AIN

General Provider Information

NPI Number : 1174169122
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER EDELEN
Provider Business Mailing Address
First Line : 8130 E SOUTHPORT RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46259-6806
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8130 E SOUTHPORT RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46259-6806
Country : US
Telephone Number : 317-245-4454
Fax Number : 317-245-4455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2019
Last Update Date : 11/25/2019

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Directions to “ CHRISTOPHER EDELEN ” Practice Location

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