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General NPI Number Information
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NPI Number | 1891396933
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Entity Type | Individual
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Provider Name | MRS. CHARISSE J BACURIO
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 2347 VETERANS MEMORIAL PKWY S
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City | LAFAYETTE
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State | IN
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Zip | 47909-9399
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Country | US
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Telephone | 765-477-9391
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 ABBOTSBURY WAY
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City | LAFAYETTE
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State | IN
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Zip | 47909-8254
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Country | US
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Telephone |
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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 | 26024137A
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License Number State | IN
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