Healthcare Provider Details

I. General information

NPI: 1285413666
Provider Name (Legal Business Name): ALLISON DUDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W NORTHFIELD DR
BROWNSBURG IN
46112-8122
US

IV. Provider business mailing address

421 E MARKET ST APT 520
INDIANAPOLIS IN
46204-2867
US

V. Phone/Fax

Practice location:
  • Phone: 317-858-0206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030471A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: