MEDICARE: MAN KUNG JAMES SHAM

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	018038	KY
2	183500000X	Pharmacist	051.302967	IL
3	183500000X	Pharmacist	26026304A	IN

General Provider Information

NPI Number	:	1215525605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAN KUNG JAMES SHAM

Provider Business Mailing Address
First Line	:	14777 DRAYTON DR
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46062-8260
Country	:	US
Telephone Number	:	859-539-6226
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 E FALL CREEK PARKWAY NORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1453
Country	:	US
Telephone Number	:	317-614-4051
Fax Number	:	317-614-4052

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

Provider Enumeration Date	:	01/02/2021
Last Update Date	:	01/02/2021

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Directions to “ MAN KUNG JAMES SHAM ” Practice Location

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