Healthcare Provider Details

I. General information

NPI: 1669183356
Provider Name (Legal Business Name): AUTUMN ELAINE MURRAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUTUMN ELAINE STOKES

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W MAIN ST
PLAINFIELD IN
46168-9407
US

IV. Provider business mailing address

3023 SUNMEADOW WAY
INDIANAPOLIS IN
46228-3193
US

V. Phone/Fax

Practice location:
  • Phone: 260-715-8884
  • Fax:
Mailing address:
  • Phone: 260-715-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030101A
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: