Provider Demographics
NPI:1073928966
Name:GARST, ERIC (RPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GARST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1515
Mailing Address - Country:US
Mailing Address - Phone:317-485-5555
Mailing Address - Fax:317-485-5565
Practice Address - Street 1:325 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1515
Practice Address - Country:US
Practice Address - Phone:317-485-5555
Practice Address - Fax:317-485-5565
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025505A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist