=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669095261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABI WESTEND PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2020
-----------------------------------------------------
Last Update Date | 12/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 855 N HIGH SCHOOL RD STE 9
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46214-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-414-1377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9678 SUMMERLAKES DR
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-9393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-414-1377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ABIMBOLA A AKIWOWO
-----------------------------------------------------
Credential | R.PH
-----------------------------------------------------
Telephone | 317-414-1377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------