Provider Demographics
NPI:1205278439
Name:FLEMING, BREANNE SORGEN (PHARMD)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:SORGEN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:NICOLE
Other - Last Name:SORGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1481 WEST 10TH STREET
Mailing Address - Street 2:ROOM C-7171
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-988-2144
Mailing Address - Fax:
Practice Address - Street 1:1481 WEST 10TH STREET
Practice Address - Street 2:ROOM C-7171
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024979A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist