Active NPI
Mitchell Charles Fairbrother, RPH
- Pharmacist
- Indianapolis, IN
National Provider Identifier
1457955700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26028582A
- Practice address
- 8405 Southeastern Ave
Indianapolis, IN 46239-1348 - Phone
- (317) 862-2414
- NPI assigned
- Nov 27, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26028582A | IN | Primary |
Addresses
Primary practice location
8405 Southeastern Ave
Indianapolis, IN 46239-1348
Mailing address
8405 Southeastern Ave
Indianapolis, IN 46239-1348
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26028582A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hook-Superx LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Indianapolis, IN
- NPI 1487757100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606435200000",
"number": "1457955700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8405 SOUTHEASTERN AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462391348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8405 SOUTHEASTERN AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462391348",
"telephone_number": "317-862-2414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRBROTHER",
"first_name": "MITCHELL",
"middle_name": "CHARLES",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-27",
"last_updated": "2020-11-27",
"certification_date": "2020-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26028582A",
"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 Nov 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.