Provider Demographics
NPI:1669917217
Name:JAMES, KIRAN (PRESIDENT)
Entity type:Individual
Prefix:MS
First Name:KIRAN
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 E WASHINGTON ST
Mailing Address - Street 2:STE 105
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3032
Mailing Address - Country:US
Mailing Address - Phone:317-591-9393
Mailing Address - Fax:
Practice Address - Street 1:9650 E WASHINGTON ST
Practice Address - Street 2:STE 105
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3032
Practice Address - Country:US
Practice Address - Phone:317-591-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27072608A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist