Provider Demographics
NPI:1730567355
Name:ELOSTATH, AHMED ABDALLA (RPH)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:ABDALLA
Last Name:ELOSTATH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 US 31 S
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8538
Mailing Address - Country:US
Mailing Address - Phone:317-888-7906
Mailing Address - Fax:
Practice Address - Street 1:7245 US 31 S
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8538
Practice Address - Country:US
Practice Address - Phone:317-888-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025985A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1063431047Medicare Oscar/Certification