Provider Demographics
NPI:1326777483
Name:ILLUMINATE HEALTH INC
Entity Type:Organization
Organization Name:ILLUMINATE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MAE GAHIMER
Authorized Official - Last Name:HYSLOP
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-512-5459
Mailing Address - Street 1:12400 N MERIDIAN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6990
Mailing Address - Country:US
Mailing Address - Phone:312-605-2390
Mailing Address - Fax:
Practice Address - Street 1:12400 N MERIDIAN ST STE 150
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6990
Practice Address - Country:US
Practice Address - Phone:312-605-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy