Provider Demographics
NPI:1578142295
Name:FEDERLE, AUDREY (PHAMRD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:FEDERLE
Suffix:
Gender:F
Credentials:PHAMRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 W MEYER LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-6618
Mailing Address - Country:US
Mailing Address - Phone:317-694-9244
Mailing Address - Fax:
Practice Address - Street 1:790 GREENSBURG COMMONS CTR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-9469
Practice Address - Country:US
Practice Address - Phone:812-663-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027911A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist