Provider Demographics
NPI:1598421075
Name:STRAKIS, KILEY JOE STOREY
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:JOE STOREY
Last Name:STRAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S FORD RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1864
Mailing Address - Country:US
Mailing Address - Phone:317-292-1737
Mailing Address - Fax:
Practice Address - Street 1:200 S FORD RD
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1864
Practice Address - Country:US
Practice Address - Phone:317-292-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCV2102511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist