Healthcare Provider Details

I. General information

NPI: 1194582221
Provider Name (Legal Business Name): RAPHAEL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 34TH ST
INDIANAPOLIS IN
46205-3754
US

IV. Provider business mailing address

401 E 34TH ST
INDIANAPOLIS IN
46205-3754
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-1507
  • Fax:
Mailing address:
  • Phone: 317-926-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN ELIZABETH CONKLIN
Title or Position: PHARMACIST
Credential: PHARMD, MPH
Phone: 920-912-7029