=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437216397
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORA APOTHECARY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 E 86TH ST
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-251-9547
-----------------------------------------------------
Fax | 317-251-9556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 E 86TH ST
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-251-9547
-----------------------------------------------------
Fax | 317-251-9556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHARLES LINDSTROM
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 317-251-9547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 60002143A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------