Healthcare Provider Details

I. General information

NPI: 1346898889
Provider Name (Legal Business Name): MILAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 N CAPITOL AVE STE 120
INDIANAPOLIS IN
46202-6403
US

IV. Provider business mailing address

1935 N CAPITOL AVE STE 120
INDIANAPOLIS IN
46202-6403
US

V. Phone/Fax

Practice location:
  • Phone: 317-755-2479
  • Fax: 317-870-3968
Mailing address:
  • Phone: 317-755-2479
  • Fax: 317-734-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLIE ATEM
Title or Position: PHARMACIST/OWNER
Credential: PHARMD
Phone: 317-755-2479