Provider Demographics
NPI:1518685494
Name:WITT, ALYSSA JAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:JAE
Last Name:WITT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 NORTHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3155
Mailing Address - Country:US
Mailing Address - Phone:765-894-2047
Mailing Address - Fax:
Practice Address - Street 1:13090 PETIGRU DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4436
Practice Address - Country:US
Practice Address - Phone:317-722-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN29026814A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist