Provider Demographics
NPI:1396027322
Name:CALISTO, RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:CALISTO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8919
Mailing Address - Country:US
Mailing Address - Phone:317-826-8790
Mailing Address - Fax:317-826-8927
Practice Address - Street 1:10845 E 79TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8919
Practice Address - Country:US
Practice Address - Phone:317-826-8790
Practice Address - Fax:317-826-8927
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020482A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist