Healthcare Provider Details

I. General information

NPI: 1659617264
Provider Name (Legal Business Name): JOELLEN E REDSHAW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 NORTH SHADELAND AVENUE SUITE 300
INDIANAPOLIS IN
46219
US

IV. Provider business mailing address

2040 NORTH SHADELAND AVENUE SUITE 300
INDIANAPOLIS IN
46219
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-3232
  • Fax: 317-355-7851
Mailing address:
  • Phone: 317-355-3232
  • Fax: 317-355-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26020690A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: