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General NPI Number Information
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NPI Number | 1124567565
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Entity Type | Organization
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Legal Business Name | EAST WASHINGTON PHARMACY LLC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 9650 E WASHINGTON ST SUITE 105
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-3032
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Country | US
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Telephone | 317-591-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 9650 E WASHINGTON ST SUITE 105
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-3032
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Country | US
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Telephone | 317-591-9393
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRAN JAMES
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Credential |
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Telephone | 317-501-9745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26021808A
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License Number State | IN
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