Healthcare Provider Details

I. General information

NPI: 1780950709
Provider Name (Legal Business Name): TANICIUS SHONTAY LAPSLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 W 38TH ST
INDIANAPOLIS IN
46254-3905
US

IV. Provider business mailing address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

V. Phone/Fax

Practice location:
  • Phone: 317-329-7806
  • Fax: 317-829-8475
Mailing address:
  • Phone: 317-988-2583
  • Fax: 317-988-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26023668A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: