Provider Demographics
NPI:1568041754
Name:DAMASIUS, NATHAN JONAS (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JONAS
Last Name:DAMASIUS
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 1:9250 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9067
Mailing Address - Country:US
Mailing Address - Phone:219-614-9470
Mailing Address - Fax:219-844-1983
Practice Address - Street 1:6949 KENNEDY AVE STE C
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2245
Practice Address - Country:US
Practice Address - Phone:219-845-2900
Practice Address - Fax:219-844-1983
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020849A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist