Healthcare Provider Details

I. General information

NPI: 1215210331
Provider Name (Legal Business Name): ABIGAIL JANE BARTHOLOMAI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2011
Last Update Date: 09/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LAFOLLETTE STA S
FLOYDS KNOBS IN
47119-9776
US

IV. Provider business mailing address

3871 HIGHLAND LAKE DR
GEORGETOWN IN
47122-9758
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-0412
  • Fax: 812-923-0622
Mailing address:
  • Phone: 812-923-0412
  • Fax: 812-923-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019624A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: