Healthcare Provider Details

I. General information

NPI: 1497342364
Provider Name (Legal Business Name): CARREN JEPCHUMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 E 86TH ST
INDIANAPOLIS IN
46240-1909
US

IV. Provider business mailing address

4405 LAKEWAY DR APT A
INDIANAPOLIS IN
46205-2574
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-1190
  • Fax:
Mailing address:
  • Phone: 978-761-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH239894
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberCV2005300
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: