Healthcare Provider Details

I. General information

NPI: 1134215833
Provider Name (Legal Business Name): PAUL JOSEPH ELMER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13018 NEW BRITTON DRIVE
FISHERS IN
46038
US

IV. Provider business mailing address

13018 NEW BRITTON DRIVE
FISHERS IN
46038
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-1059
  • Fax: 317-818-1094
Mailing address:
  • Phone: 317-818-1059
  • Fax: 317-818-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26013086
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: