MEDICARE: MR. BRIAN W MUSIAL R.PH.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	26015770A	IN
2	302R00000X	Health Maintenance Organization	26015770A	IN

General Provider Information

NPI Number	:	1417220955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN W MUSIAL R.PH.

Provider Business Mailing Address
First Line	:	2955 N MERIDIAN ST STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-5195
Country	:	US
Telephone Number	:	317-822-7523
Fax Number	:	317-822-7523

Provider Business Practice Location Address
First Line	:	2955 N MERIDIAN ST STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-5195
Country	:	US
Telephone Number	:	317-822-7523
Fax Number	:	317-822-7523

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

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	12/06/2019

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