Individual
DEVON BASCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3828 KNICKERBOCKER PL APT T1, INDIANAPOLIS, IN 46240-4684
(585) 747-9522
Mailing address
3828 KNICKERBOCKER PL APT T1, INDIANAPOLIS, IN 46240-4684
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26025278A
IN
Other
Enumeration date
08/07/2013
Last updated
08/07/2013
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