Provider Demographics
NPI:1588487631
Name:BANKS, NATALIE GRACE (RPH)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:GRACE
Last Name:BANKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1934
Mailing Address - Country:US
Mailing Address - Phone:574-806-1591
Mailing Address - Fax:
Practice Address - Street 1:975 N GREEN ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1032
Practice Address - Country:US
Practice Address - Phone:317-852-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030803A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26030803AOtherBOARD OF PHARMACY