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General NPI Number Information
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NPI Number | 1235913500
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Entity Type | Individual
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Provider Name | VIVIAN MARIE KADUS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 11109 PARKVIEW PLAZA DR
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone | 260-266-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 124 W SUPERIOR ST UNIT 501
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City | FORT WAYNE
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State | IN
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Zip | 46802-1251
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Country | US
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Telephone | 773-573-6749
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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 | 26030005A
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License Number State | IN
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