Healthcare Provider Details

I. General information

NPI: 1285874586
Provider Name (Legal Business Name): KATHERINE NICOLE BRADNER PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N MERIDIAN ST SUITE 500
INDIANAPOLIS IN
46204-1077
US

IV. Provider business mailing address

950 N MERIDIAN ST SUITE 500
INDIANAPOLIS IN
46204-1077
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-0377
  • Fax: 317-962-4070
Mailing address:
  • Phone: 317-963-0377
  • Fax: 317-962-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26022559A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: