Provider Demographics
NPI:1760085294
Name:BODNAR, CIARRA
Entity Type:Individual
Prefix:
First Name:CIARRA
Middle Name:
Last Name:BODNAR
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 1:1299 W SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-4174
Mailing Address - Country:US
Mailing Address - Phone:317-859-5881
Mailing Address - Fax:317-865-7544
Practice Address - Street 1:1299 W SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-4174
Practice Address - Country:US
Practice Address - Phone:317-859-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028381A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist