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General NPI Number Information
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NPI Number | 1023636867
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Entity Type | Individual
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Provider Name | LENA DANIELLE CLOUSE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | GENOA HEALTHCARE LLC 8555 TAFT STREET
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 219-769-8171
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Fax | 219-769-8176
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Provider Business Mailing Address
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Address Line | 12806 FAWN CT
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City | CEDAR LAKE
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State | IN
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Zip | 46303-8675
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Country | US
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Telephone | 219-771-0102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26022500A
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License Number State | IN
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