Provider Demographics
NPI:1093301806
Name:BAUTISTA, AIZEL JOY S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AIZEL JOY
Middle Name:S
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 OAK LEAF DR APT A5
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3362
Mailing Address - Country:US
Mailing Address - Phone:773-716-4886
Mailing Address - Fax:
Practice Address - Street 1:5220 OAK LEAF DR APT A5
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3362
Practice Address - Country:US
Practice Address - Phone:773-716-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028913A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26028913AOtherINDIANA BOARD OF PHARMACY