MEDICARE: DR. BRIEE MYLEAH KULESA PHARMD

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	26028274A	IN

General Provider Information

NPI Number	:	1912674243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIEE MYLEAH KULESA PHARMD

Provider Business Mailing Address
First Line	:	949 CAMP ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3051
Country	:	US
Telephone Number	:	574-806-2031
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 SIERRA DR STE 1400
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7240
Country	:	US
Telephone Number	:	317-528-7072
Fax Number	:

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

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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