Healthcare Provider Details

I. General information

NPI: 1962093484
Provider Name (Legal Business Name): GILBERT CHAVARRIA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5173 W WASHINGTON ST
INDIANAPOLIS IN
46241-2205
US

IV. Provider business mailing address

5173 W WASHINGTON ST
INDIANAPOLIS IN
46241-2205
US

V. Phone/Fax

Practice location:
  • Phone: 317-381-9659
  • Fax: 317-381-9678
Mailing address:
  • Phone: 317-381-9659
  • Fax: 317-381-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26019304A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: