Provider Demographics
NPI:1508466996
Name:SHOEMAKER, DANA MICHELLE (RPH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:SHOEMAKER
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 1:2529 WALDON DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8271
Mailing Address - Country:US
Mailing Address - Phone:317-670-8959
Mailing Address - Fax:
Practice Address - Street 1:3805 S KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3540
Practice Address - Country:US
Practice Address - Phone:317-786-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018582A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist