Provider Demographics
NPI:1376148221
Name:WEBB, GERALYN BERNICE (RPH)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:BERNICE
Last Name:WEBB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2901
Mailing Address - Country:US
Mailing Address - Phone:317-783-5325
Mailing Address - Fax:317-783-5912
Practice Address - Street 1:6010 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2901
Practice Address - Country:US
Practice Address - Phone:317-783-5325
Practice Address - Fax:317-783-5912
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03116295183500000X
IN26015681A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist