Provider Demographics
NPI:1790986743
Name:KAPLAN, IVAN M (RPH)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:M
Last Name:KAPLAN
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 1:9466 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2812
Mailing Address - Country:US
Mailing Address - Phone:219-836-1899
Mailing Address - Fax:219-836-2464
Practice Address - Street 1:9466 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2812
Practice Address - Country:US
Practice Address - Phone:219-836-1899
Practice Address - Fax:219-836-2464
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012668A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist