Healthcare Provider Details

I. General information

NPI: 1053912139
Provider Name (Legal Business Name): JOY DOHMEYER READ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALMART 2373 E MAIN STREET
PLAINFIELD IN
46168
US

IV. Provider business mailing address

7796 WOODEN SHOE CIR
AVON IN
46123-4683
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-3881
  • Fax:
Mailing address:
  • Phone: 317-850-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26015275A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: