Provider Demographics
NPI:1194403147
Name:ANTONIAN, SAMUEL ALAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ALAN
Last Name:ANTONIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8122
Mailing Address - Country:US
Mailing Address - Phone:317-858-1415
Mailing Address - Fax:
Practice Address - Street 1:400 W NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8122
Practice Address - Country:US
Practice Address - Phone:317-858-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030313A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist