Provider Demographics
NPI:1861038937
Name:CARDENAS, THELMA N
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:N
Last Name:CARDENAS
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 1:534 INGRAM DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-6350
Mailing Address - Country:US
Mailing Address - Phone:765-237-7504
Mailing Address - Fax:
Practice Address - Street 1:65 BECK LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2836
Practice Address - Country:US
Practice Address - Phone:765-474-8269
Practice Address - Fax:765-471-9674
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027223A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist