Provider Demographics
NPI:1558623017
Name:BERNAUER, JAMES PHILLIP (PHARMD, RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PHILLIP
Last Name:BERNAUER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14625 N GRAY RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9274
Mailing Address - Country:US
Mailing Address - Phone:317-815-6619
Mailing Address - Fax:317-815-6681
Practice Address - Street 1:14625 N GRAY RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46062-9274
Practice Address - Country:US
Practice Address - Phone:317-815-6619
Practice Address - Fax:317-815-6681
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019018A183500000X
IN26019081A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26019018AOtherSTATE LICENSE NUMBER