Provider Demographics
NPI:1528396926
Name:OVERHOLSER, BRIAN R (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:OVERHOLSER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W 10TH ST
Mailing Address - Street 2:W7555 MYERS BLDG, WHS
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2859
Mailing Address - Country:US
Mailing Address - Phone:317-613-2315
Mailing Address - Fax:317-613-2316
Practice Address - Street 1:1001 W 10TH ST
Practice Address - Street 2:W7555 MYERS BLDG, WHS
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2859
Practice Address - Country:US
Practice Address - Phone:317-613-2315
Practice Address - Fax:317-613-2316
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020989A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist