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NPI Code Detail

MEDICARE: MICHAEL TYLER LAUTENBACH RPH

MEDICARE: MICHAEL TYLER LAUTENBACH RPH
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
1183500000XPharmacist26031573AIN

General Provider Information

NPI Number : 1679413793
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL TYLER LAUTENBACH RPH
Provider Business Mailing 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 : 317-387-2465
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 : 317-387-2465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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