Provider Demographics
NPI:1124990676
Name:EMAX HEALTH PATIENT SERVICES
Entity type:Organization
Organization Name:EMAX HEALTH PATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:812-989-5406
Mailing Address - Street 1:306 SQUIRE HILL DR
Mailing Address - Street 2:
Mailing Address - City:OTISCO
Mailing Address - State:IN
Mailing Address - Zip Code:47163-9609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1840 OUTER LOOP STE A-101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3429
Practice Address - Country:US
Practice Address - Phone:812-989-5406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMAX HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-23
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy