MEDICARE: AMY WAYMIRE RPH

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
1	183500000X	Pharmacist	PS53081	FL
2	183500000X	Pharmacist	26016426A	IN

General Provider Information

NPI Number	:	1396338679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY WAYMIRE RPH

Provider Business Mailing Address
First Line	:	5550 E FALL CREEK PARKWAY NORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1453
Country	:	US
Telephone Number	:	317-614-4046
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 E FALL CREEK PARKWAY NORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1453
Country	:	US
Telephone Number	:	317-614-4046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	02/17/2021

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