=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487389359
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY LANGEMEIER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2022
-----------------------------------------------------
Last Update Date | 07/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5718 CRAWFORDSVILLE RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46224-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-240-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3609 NIKOLE DR
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47905-8870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-410-7690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 26029817A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------