Provider Demographics
NPI:1346898889
Name:MILAN PHARMACY INC
Entity Type:Organization
Organization Name:MILAN PHARMACY INC
Other - Org Name:MILAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-755-2479
Mailing Address - Street 1:1935 N CAPITOL AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-6403
Mailing Address - Country:US
Mailing Address - Phone:317-755-2479
Mailing Address - Fax:317-734-3354
Practice Address - Street 1:1935 N CAPITOL AVE STE 120
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-6403
Practice Address - Country:US
Practice Address - Phone:317-755-2479
Practice Address - Fax:317-870-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300030711Medicaid