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General NPI Number Information
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NPI Number | 1841910312
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Entity Type | Individual
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Provider Name | AUSTIN TYLER WOOTEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 1701 N SENATE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5306
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Country | US
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Telephone | 812-786-5714
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Fax |
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Provider Business Mailing Address
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Address Line | 350 MONON BLVD APT 123
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City | CARMEL
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State | IN
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Zip | 46032-2356
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Country | US
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Telephone | 812-786-5714
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Fax | 857-770-9648
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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 | 26029309A
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License Number State | IN
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