Provider Demographics
NPI:1982299152
Name:VARE, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:VARE
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 1:484 E CARMEL DR STE 135
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2812
Mailing Address - Country:US
Mailing Address - Phone:317-250-7453
Mailing Address - Fax:
Practice Address - Street 1:711 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1921
Practice Address - Country:US
Practice Address - Phone:765-675-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020381A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist