Provider Demographics
NPI:1568734507
Name:PRYOR, ENDALISH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ENDALISH
Middle Name:
Last Name:PRYOR
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 1:6101 N KEYSTONE AVE
Mailing Address - Street 2:T-2391
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2488
Mailing Address - Country:US
Mailing Address - Phone:317-454-7505
Mailing Address - Fax:317-454-7515
Practice Address - Street 1:6101 N KEYSTONE AVE
Practice Address - Street 2:T-2391
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2488
Practice Address - Country:US
Practice Address - Phone:317-454-7505
Practice Address - Fax:317-454-7515
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023912A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26023912AOtherSTATE LICENSE NUMBER