Provider Demographics
NPI:1538763289
Name:INGLE, ABHIMANYU RAMESH
Entity type:Individual
Prefix:
First Name:ABHIMANYU
Middle Name:RAMESH
Last Name:INGLE
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 1:255 OLD CAPITAL PLZ NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2081
Mailing Address - Country:US
Mailing Address - Phone:812-738-7191
Mailing Address - Fax:
Practice Address - Street 1:255 OLD CAPITAL PLZ NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2081
Practice Address - Country:US
Practice Address - Phone:812-738-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021543A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist