Healthcare Provider Details

I. General information

NPI: 1801174156
Provider Name (Legal Business Name): CATHALEAH PIMSAKUL STANLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N MERIDIAN ST SUITE 100A
INDIANAPOLIS IN
46202-1468
US

IV. Provider business mailing address

1776 N MERIDIAN ST SUITE 100A
INDIANAPOLIS IN
46202-1468
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-3295
  • Fax: 317-962-2030
Mailing address:
  • Phone: 317-963-3295
  • Fax: 317-962-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26023845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: