Healthcare Provider Details

I. General information

NPI: 1316868730
Provider Name (Legal Business Name): RYAN EDNALINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W MICHIGAN ST RM C2102
INDIANAPOLIS IN
46202-5201
US

IV. Provider business mailing address

16547 MAINES VALLEY DR
NOBLESVILLE IN
46062-6886
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-0369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number26021750A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: