Provider Demographics
NPI:1114088911
Name:FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEWEESE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-735-4444
Mailing Address - Street 1:508 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-9626
Mailing Address - Country:US
Mailing Address - Phone:812-735-4444
Mailing Address - Fax:812-735-3017
Practice Address - Street 1:508 W 11TH ST
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512-9626
Practice Address - Country:US
Practice Address - Phone:812-735-4444
Practice Address - Fax:812-735-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60002628A332B00000X, 332BN1400X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1519454OtherNABP
IN000000097231OtherANTHEM BLUE DME NUMBER
IN000000216711OtherANTHEM BLUE ORTH & PROS
IN=========OtherFEDERAL ID NUMBER
IN=========-050OtherCARESOURCE NUMBER
IN=========-050OtherCARESOURCE NUMBER