Individual
NEGATU B DESTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4401 E 10TH ST, INDIANAPOLIS, IN 46201-2744
(317) 460-9647
Mailing address
4401 E 10TH ST, INDIANAPOLIS, IN 46201-2744
(317) 460-9647
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
26031170A
IN
Other
Enumeration date
07/30/2025
Last updated
07/30/2025
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