Provider Demographics
NPI:1528016136
Name:LINTON FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:LINTON FAMILY PHARMACY INC
Other - Org Name:LINTON FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PRES,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-847-1978
Mailing Address - Street 1:60 A ST NW
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-1801
Mailing Address - Country:US
Mailing Address - Phone:812-847-1978
Mailing Address - Fax:812-847-1985
Practice Address - Street 1:60 A ST NW
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-1801
Practice Address - Country:US
Practice Address - Phone:812-847-1978
Practice Address - Fax:812-847-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
IN60005942A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200139830AMedicaid
2028263OtherPK
IN200139830AMedicaid