Provider Demographics
NPI:1710583463
Name:UPDEGRAFF, DAKIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAKIN
Middle Name:
Last Name:UPDEGRAFF
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7284 W 1300 N
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-9210
Mailing Address - Country:US
Mailing Address - Phone:765-639-2450
Mailing Address - Fax:
Practice Address - Street 1:9900 WESTPOINT DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3358
Practice Address - Country:US
Practice Address - Phone:765-639-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028765A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist