Healthcare Provider Details

I. General information

NPI: 1437060555
Provider Name (Legal Business Name): BLAKE ANDREW MATHIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 S RANGELINE RD
CARMEL IN
46032-2934
US

IV. Provider business mailing address

1424 S RANGELINE RD
CARMEL IN
46032-2934
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-1176
  • Fax: 317-575-0037
Mailing address:
  • Phone: 317-571-1176
  • Fax: 317-575-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032238A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: