1174817308 NPI number — MRS. ELIZABETH ELLEN KREMER PHARMD

Table of content: MRS. ELIZABETH ELLEN KREMER PHARMD (NPI 1174817308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174817308 NPI number — MRS. ELIZABETH ELLEN KREMER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREMER
Provider First Name:
ELIZABETH
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174817308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 E 86TH ST STE 35
Provider Second Line Business Mailing Address:
T-1848
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46240-1990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-810-0045
Provider Business Mailing Address Fax Number:
317-810-8171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 E 86TH ST STE 35
Provider Second Line Business Practice Location Address:
T-1848
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46240-1990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-810-0045
Provider Business Practice Location Address Fax Number:
317-810-8171
Provider Enumeration Date:
06/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  26022049A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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