Healthcare Provider Details

I. General information

NPI: 1326968405
Provider Name (Legal Business Name): SIERRA RAE MIDKIFF
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E LAGRANGE RD
HANOVER IN
47243-9447
US

IV. Provider business mailing address

259 N BOATMAN RD
SCOTTSBURG IN
47170-7941
US

V. Phone/Fax

Practice location:
  • Phone: 812-866-5599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030174A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: