Provider Demographics
NPI:1942632864
Name:FURLONG, KIRSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:FURLONG
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 1:4623 CAMERON RIDGE DR
Mailing Address - Street 2:APT 126
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7802
Mailing Address - Country:US
Mailing Address - Phone:614-506-8839
Mailing Address - Fax:
Practice Address - Street 1:9610 ALLISONVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2910
Practice Address - Country:US
Practice Address - Phone:317-578-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025225A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist