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NPI Code Detail

MEDICARE: KENDRA ANN NESIUS LUCAS

MEDICARE: KENDRA ANN NESIUS LUCAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26028425AIN
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist26028425AIN

General Provider Information

NPI Number : 1326684127
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA ANN NESIUS LUCAS
Provider Business Mailing Address
First Line : 4202 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1416
Country : US
Telephone Number : 317-781-4258
Fax Number :
Provider Business Practice Location Address
First Line : 4202 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1416
Country : US
Telephone Number : 317-781-4258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2019
Last Update Date : 01/24/2020

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Directions to “ KENDRA ANN NESIUS LUCAS ” Practice Location

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