Autumn Pancake
Individual provider Active NPI Pharmacist · Boonville, IN
NPI 1699503540 · NPPES record last updated Jul 23, 2024
Key facts
- NPI
- 1699503540
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26030832A (IN)
- Practice address
- 1115 American Way
Boonville, IN 47601-8604 - Phone
- (812) 897-0089
- NPI assigned
- Jul 23, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26030832A | IN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26030832A | IN | Yes |
Addresses
Primary practice location
1115 American Way
Boonville, IN 47601-8604
Mailing address
1115 American Way
Boonville, IN 47601-8604
Other providers in Boonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.