Healthcare Provider Details

I. General information

NPI: 1750891180
Provider Name (Legal Business Name): NOAH VASILAKES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 HIGHLANDER POINT DR
FLOYDS KNOBS IN
47119-9470
US

IV. Provider business mailing address

3315 SCHNEITER AVE
LOUISVILLE KY
40215-1938
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-8829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019389
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26027407A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: