Healthcare Provider Details

I. General information

NPI: 1265357693
Provider Name (Legal Business Name): ALEXANDRA PRIVAT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE RM B222
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

410 N MERIDIAN ST APT 410
INDIANAPOLIS IN
46204-1770
US

V. Phone/Fax

Practice location:
  • Phone: 469-219-9154
  • Fax:
Mailing address:
  • Phone: 469-219-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032045A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: