Healthcare Provider Details

I. General information

NPI: 1053648394
Provider Name (Legal Business Name): ELAYNE D ANSARA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6352 HARMONRIDGE CT
INDIANAPOLIS IN
46278-2218
US

IV. Provider business mailing address

1841 WEST 10TH STREET
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-225-9437
  • Fax:
Mailing address:
  • Phone: 317-988-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number26022119A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: