Healthcare Provider Details

I. General information

NPI: 1063109643
Provider Name (Legal Business Name): TERESA NICOLE DILGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE # AG401
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

1701 N SENATE AVE # AG401
INDIANAPOLIS IN
46202-5306
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8893
  • Fax: 317-962-1049
Mailing address:
  • Phone: 317-962-8893
  • Fax: 317-962-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26029736A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: