Healthcare Provider Details

I. General information

NPI: 1568392330
Provider Name (Legal Business Name): AISLINN PRUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AISLINN O'KANE

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

339 CENTRAL STATE BLVD
INDIANAPOLIS IN
46222-0105
US

V. Phone/Fax

Practice location:
  • Phone: 720-595-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number26029975A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: