Provider Demographics
NPI:1164068755
Name:DISHMAN, MEGAN MARTHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARTHA
Last Name:DISHMAN
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 1:828 GONDOLA RUN
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7254
Mailing Address - Country:US
Mailing Address - Phone:765-265-7205
Mailing Address - Fax:
Practice Address - Street 1:5350 E THOMPSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2059
Practice Address - Country:US
Practice Address - Phone:317-781-3566
Practice Address - Fax:317-781-3567
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027694A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist