Healthcare Provider Details

I. General information

NPI: 1356253389
Provider Name (Legal Business Name): TIFFANI RAE HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANI RAE SAHULCIK

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10580 N MERIDIAN ST
CARMEL IN
46290-1028
US

IV. Provider business mailing address

10580 N MERIDIAN ST
CARMEL IN
46290-1028
US

V. Phone/Fax

Practice location:
  • Phone: 317-260-9021
  • Fax: 317-583-5163
Mailing address:
  • Phone: 317-583-5160
  • Fax: 317-583-5163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0206X
TaxonomyCardiology Pharmacist
License Number26020560A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: