MEDICARE: SHIRLEY LOUISE PADDOCK 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
1	183500000X	Pharmacist	26016991A	IN

General Provider Information

NPI Number	:	1851944433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY LOUISE PADDOCK RPH

Provider Business Mailing Address
First Line	:	11761 DARSLEY DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-8281
Country	:	US
Telephone Number	:	317-332-4265
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 ENTERPRISE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1103
Country	:	US
Telephone Number	:	888-607-4287
Fax Number	:

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

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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