Provider Demographics
NPI:1740876705
Name:SISIL, DARIN
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:SISIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S SECTION ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1808
Mailing Address - Country:US
Mailing Address - Phone:812-268-6827
Mailing Address - Fax:812-268-3015
Practice Address - Street 1:275 S SECTION ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-1808
Practice Address - Country:US
Practice Address - Phone:812-268-6827
Practice Address - Fax:812-268-3015
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018341A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist