Provider Demographics
NPI:1003486705
Name:YOUSAF, SHAUKAT
Entity Type:Individual
Prefix:
First Name:SHAUKAT
Middle Name:
Last Name:YOUSAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11915 GRAY EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8114
Mailing Address - Country:US
Mailing Address - Phone:317-504-1436
Mailing Address - Fax:
Practice Address - Street 1:5550 E FALL CREEK PARKWAY NORTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1453
Practice Address - Country:US
Practice Address - Phone:317-614-4046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022058A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist