Individual
RANDY W IVANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
3205 E WASHINGTON ST, INDIANAPOLIS, IN 46201-4207
(317) 681-1111
Mailing address
3205 E WASHINGTON ST, INDIANAPOLIS, IN 46201-4207
(317) 681-1111
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26023680A
IN
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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