Provider Demographics
NPI:1598158016
Name:GARST RX LLC
Entity Type:Organization
Organization Name:GARST RX LLC
Other - Org Name:GARST RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GARST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-225-2112
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006446A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150565OtherPK
IN201283850 AMedicaid
IN7525980001Medicare NSC