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NPI Code Detail

MEDICARE: EBONY PATHAK PHARM.D.

MEDICARE: EBONY PATHAK PHARM.D.
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
1183500000XPharmacist26022588AIN

General Provider Information

NPI Number : 1659811289
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY PATHAK PHARM.D.
Provider Business Mailing Address
First Line : 4023 N PARK AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-2740
Country : US
Telephone Number : 317-469-3766
Fax Number :
Provider Business Practice Location Address
First Line : 5349 W PIKE PLAZA RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-3011
Country : US
Telephone Number : 317-387-2410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2017
Last Update Date : 03/01/2017

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