Provider Demographics
NPI:1952661092
Name:INDENBAUM, ANNA (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:INDENBAUM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 OCEAN PKWY
Mailing Address - Street 2:6 C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7903
Mailing Address - Country:US
Mailing Address - Phone:718-288-3255
Mailing Address - Fax:
Practice Address - Street 1:373 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8025
Practice Address - Country:US
Practice Address - Phone:718-743-1600
Practice Address - Fax:718-743-9800
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist