Active NPI
Negatu B Desta
- Community/Retail Pharmacy
- Indianapolis, IN
National Provider Identifier
1427931096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 26031170A
- Practice address
- 4401 E 10TH St
Indianapolis, IN 46201-2744 - Phone
- (317) 460-9647
- NPI assigned
- Jul 30, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 26031170A | IN | Primary |
Addresses
Primary practice location
4401 E 10TH St
Indianapolis, IN 46201-2744
Mailing address
4401 E 10TH St
Indianapolis, IN 46201-2744
Phone (317) 460-9647
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26031170A | IN | MD | Community/Retail Pharmacy |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753833600000",
"number": "1427931096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 E 10TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462012744",
"telephone_number": "317-460-9647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 E 10TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462012744",
"telephone_number": "317-460-9647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTA",
"first_name": "NEGATU",
"middle_name": "B",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-30",
"last_updated": "2025-07-30",
"certification_date": "2025-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IN",
"license": "26031170A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.