Provider Demographics
NPI:1235461377
Name:INDIHAR, JUSTIN T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:T
Last Name:INDIHAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-1732
Mailing Address - Country:US
Mailing Address - Phone:256-593-6092
Mailing Address - Fax:256-593-7445
Practice Address - Street 1:920 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-1732
Practice Address - Country:US
Practice Address - Phone:256-593-6092
Practice Address - Fax:256-593-7445
Is Sole Proprietor?:No
Enumeration Date:2010-01-30
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16333183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy