Healthcare Provider Details

I. General information

NPI: 1811726896
Provider Name (Legal Business Name): MONTANA ELAINE OGDEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MARKET ST
CRAWFORDSVILLE IN
47933-1720
US

IV. Provider business mailing address

3204 TANAGER DR
LAFAYETTE IN
47909-4406
US

V. Phone/Fax

Practice location:
  • Phone: 765-362-1139
  • Fax:
Mailing address:
  • Phone: 765-716-7097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030830A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: