Provider Demographics
NPI:1265290407
Name:ADILEH, LANA
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:ADILEH
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 1:14243 KODIAK DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7757
Mailing Address - Country:US
Mailing Address - Phone:847-630-3305
Mailing Address - Fax:
Practice Address - Street 1:5550 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3458
Practice Address - Country:US
Practice Address - Phone:317-610-2210
Practice Address - Fax:317-205-8065
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030226A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy