Healthcare Provider Details

I. General information

NPI: 1629483615
Provider Name (Legal Business Name): DAVID ALEXANDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 BREMEN HWY
MISHAWAKA IN
46544-6500
US

IV. Provider business mailing address

58781 APPLE RD
OSCEOLA IN
46561-9391
US

V. Phone/Fax

Practice location:
  • Phone: 574-254-2510
  • Fax: 574-254-2565
Mailing address:
  • Phone: 574-674-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26024013A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: