Healthcare Provider Details

I. General information

NPI: 1255235420
Provider Name (Legal Business Name): ALAN RUSNAK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W MICHIGAN ST
INDIANAPOLIS IN
46202-5201
US

IV. Provider business mailing address

5234 WILTONWOOD CT
INDIANAPOLIS IN
46254-9665
US

V. Phone/Fax

Practice location:
  • Phone: 864-650-3180
  • Fax:
Mailing address:
  • Phone: 864-650-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26025991A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: