Provider Demographics
NPI:1043814338
Name:MACHIN, MARCIA JOANN
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:JOANN
Last Name:MACHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1401
Mailing Address - Country:US
Mailing Address - Phone:317-254-8921
Mailing Address - Fax:317-254-8927
Practice Address - Street 1:5005 E 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1401
Practice Address - Country:US
Practice Address - Phone:317-254-8921
Practice Address - Fax:317-254-8927
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015431A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist