Provider Demographics
NPI:1760750772
Name:DEAL, F K (RPH)
Entity Type:Individual
Prefix:
First Name:F
Middle Name:K
Last Name:DEAL
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 1:7236 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2408
Mailing Address - Country:US
Mailing Address - Phone:219-937-0337
Mailing Address - Fax:219-852-8709
Practice Address - Street 1:7236 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2408
Practice Address - Country:US
Practice Address - Phone:219-937-0337
Practice Address - Fax:219-852-8709
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26091077A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1588679690Medicaid