Individual
RICHARD LAUREL FATTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1410 W 10TH ST, INDIANAPOLIS, IN 46209-0001
(317) 988-2828
Mailing address
1481 W. 19TH ST, INDIANAPOLIS, IN 46209-0291
(317) 988-2828
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26013090A
IN
Other
Enumeration date
01/28/2008
Last updated
01/28/2008
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