Harold Shane Anderson
Individual provider Active NPI Pharmacist · Portland, IN
NPI 1982209722 · NPPES record last updated Dec 1, 2020
Key facts
- NPI
- 1982209722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26019299A (IN)
- Practice address
- 950 W Votaw St
Portland, IN 47371-1254 - Phone
- (260) 726-3782
- Fax
- (260) 726-3785
- NPI assigned
- Dec 1, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 26019299A | IN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26019299A | IN | Yes |
Addresses
Primary practice location
950 W Votaw St
Portland, IN 47371-1254
Mailing address
950 W Votaw St
Portland, IN 47371-1254
Phone (260) 726-3782
Other providers in Portland, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2020. 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.