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General NPI Number Information
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NPI Number | 1669018883
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Entity Type | Individual
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Provider Name | JENNA MICHELLE SHUKLA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 5911 MADISON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-4726
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Country | US
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Telephone | 317-791-3545
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Fax | 317-791-3547
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Provider Business Mailing Address
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Address Line | 8447 CLEARWATER LN APT 106
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1673
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Country | US
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Telephone | 317-512-8854
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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 | 018726
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26026631A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 018726
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 26026631A
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License Number State | IN
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