Healthcare Provider Details

I. General information

NPI: 1336257658
Provider Name (Legal Business Name): JOAN L HANCOCK R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 CENTURY PLAZA RD STE 150
INDIANAPOLIS IN
46254-5473
US

IV. Provider business mailing address

6807 E 525 S
WHITESTOWN IN
46075-9692
US

V. Phone/Fax

Practice location:
  • Phone: 317-216-2900
  • Fax:
Mailing address:
  • Phone: 317-769-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26013110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: