Healthcare Provider Details

I. General information

NPI: 1265369136
Provider Name (Legal Business Name): DR. CELINE KASSAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W STATE ROAD 46
BLOOMINGTON IN
47404-2605
US

IV. Provider business mailing address

620 S PEYTON CIR APT 201
BLOOMINGTON IN
47404-8041
US

V. Phone/Fax

Practice location:
  • Phone: 812-876-2915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031835A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: