Provider Demographics
NPI:1811536840
Name:IFTIKHAR, EZZA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EZZA
Middle Name:
Last Name:IFTIKHAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 EVERGREEN TRL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7761
Mailing Address - Country:US
Mailing Address - Phone:317-373-4922
Mailing Address - Fax:
Practice Address - Street 1:873 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5804
Practice Address - Country:US
Practice Address - Phone:317-580-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027362A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist