Provider Demographics
NPI:1609428473
Name:SMITH, ANNALISSA ABAD
Entity Type:Individual
Prefix:
First Name:ANNALISSA
Middle Name:ABAD
Last Name:SMITH
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 1:6140 N SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5123
Mailing Address - Country:US
Mailing Address - Phone:317-341-2570
Mailing Address - Fax:
Practice Address - Street 1:11591 OLIO RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7613
Practice Address - Country:US
Practice Address - Phone:317-585-2702
Practice Address - Fax:317-585-6918
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020611A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist