Provider Demographics
NPI:1609917020
Name:AWISHES, ANTHONY BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:BRUCE
Last Name:AWISHES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13137 STAR CIR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-5980
Mailing Address - Country:US
Mailing Address - Phone:317-770-0674
Mailing Address - Fax:
Practice Address - Street 1:4005 W KILGORE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4815
Practice Address - Country:US
Practice Address - Phone:765-286-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020967A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist