Provider Demographics
NPI:1962028639
Name:LUDLOW, SAMUEL (PHARMD, MBA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1791
Mailing Address - Country:US
Mailing Address - Phone:317-838-9187
Mailing Address - Fax:
Practice Address - Street 1:1516 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1791
Practice Address - Country:US
Practice Address - Phone:317-838-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028372A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist