Healthcare Provider Details

I. General information

NPI: 1508787425
Provider Name (Legal Business Name): GINA BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W STATE BLVD
FORT WAYNE IN
46808-3135
US

IV. Provider business mailing address

205 N MAIN ST APT A
AUBURN IN
46706-1858
US

V. Phone/Fax

Practice location:
  • Phone: 260-482-5428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: