Healthcare Provider Details

I. General information

NPI: 1811597271
Provider Name (Legal Business Name): PHILIP EDWARD HYNDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 E MAIN ST
PLAINFIELD IN
46168-2717
US

IV. Provider business mailing address

5800 KENWOOD WAY
PLAINFIELD IN
46168-7734
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-3881
  • Fax: 317-839-4438
Mailing address:
  • Phone: 317-431-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016646A
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: