Provider Demographics
NPI:1386480408
Name:COLEMEN, ASHANTA DOMONIQUE (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHANTA
Middle Name:DOMONIQUE
Last Name:COLEMEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11039 BEAR HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3119
Mailing Address - Country:US
Mailing Address - Phone:317-374-7339
Mailing Address - Fax:
Practice Address - Street 1:333 E COUNTY LINE RD STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1080
Practice Address - Country:US
Practice Address - Phone:317-887-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030402A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care