Healthcare Provider Details

I. General information

NPI: 1598649451
Provider Name (Legal Business Name): ALYSA HAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAE-MAE HAN

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 W PIKE PLAZA RD
INDIANAPOLIS IN
46254-3011
US

IV. Provider business mailing address

16279 NORTHWIND CT
WESTFIELD IN
46074-7882
US

V. Phone/Fax

Practice location:
  • Phone: 317-387-2410
  • Fax: 317-387-2465
Mailing address:
  • Phone: 317-908-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: