Healthcare Provider Details

I. General information

NPI: 1629300967
Provider Name (Legal Business Name): TIMOTHY M FUHRMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E MAIN ST
PLAINFIELD IN
46168-1859
US

IV. Provider business mailing address

1930 E MAIN ST
PLAINFIELD IN
46168-1859
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-5149
  • Fax: 317-838-3500
Mailing address:
  • Phone: 317-839-5149
  • Fax: 317-247-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26019994A
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: