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General NPI Number Information
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NPI Number | 1912538034
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Entity Type | Individual
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Provider Name | MICHAELA ROSE CLAGUE PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 550 UNIVERSITY BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5149
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Country | US
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Telephone | 734-649-1357
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Fax |
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Provider Business Mailing Address
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Address Line | 6014 SYCAMORE FORGE LN
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-1293
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Country | US
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Telephone | 734-649-1357
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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 | 26030416A
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License Number State | IN
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