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General NPI Number Information
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NPI Number | 1053260844
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Entity Type | Organization
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Legal Business Name | SELF-ISH RX
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Dates
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Enumeration Date | 01/24/2026
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 219 E 9TH ST
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-3523
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Country | US
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Telephone | 219-877-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 5475 BROADWAY UNIT A300
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1647
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Country | US
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Telephone | 219-877-9353
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | MRS. DANNON RAE MARTIN WALKER
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Credential | PA-C
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Telephone | 219-877-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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