Healthcare Provider Details

I. General information

NPI: 1639774599
Provider Name (Legal Business Name): DR. CARLY KARTHAUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7990 E US HIGHWAY 36
AVON IN
46123-7790
US

IV. Provider business mailing address

7990 E US HIGHWAY 36
AVON IN
46123-7790
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-0242
  • Fax: 317-272-7219
Mailing address:
  • Phone: 317-272-0242
  • Fax: 317-272-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26028762A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: