Provider Demographics
NPI:1730590191
Name:DITTMANN, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:DITTMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 W 92ND LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7444
Mailing Address - Country:US
Mailing Address - Phone:219-558-8063
Mailing Address - Fax:
Practice Address - Street 1:10138 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3501
Practice Address - Country:US
Practice Address - Phone:219-934-2110
Practice Address - Fax:219-934-2165
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019172A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy