Healthcare Provider Details

I. General information

NPI: 1609428473
Provider Name (Legal Business Name): ANNALISSA ABAD SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11591 OLIO RD
FISHERS IN
46037-7613
US

IV. Provider business mailing address

6140 N SHERMAN DR
INDIANAPOLIS IN
46220-5123
US

V. Phone/Fax

Practice location:
  • Phone: 317-585-2702
  • Fax: 317-585-6918
Mailing address:
  • Phone: 317-341-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020611A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: