Healthcare Provider Details

I. General information

NPI: 1720838162
Provider Name (Legal Business Name): HANNAH RUTH VYAIN PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 STATE ROAD 26 E
LAFAYETTE IN
47905-4611
US

IV. Provider business mailing address

210 TERRACE LN
LEBANON IN
46052-1182
US

V. Phone/Fax

Practice location:
  • Phone: 765-449-9210
  • Fax:
Mailing address:
  • Phone: 317-771-9736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030676A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: