Provider Demographics
NPI:1609384684
Name:GEORGE'S FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:GEORGE'S FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-647-6251
Mailing Address - Street 1:1198 STATE ROAD 46 E
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-9232
Mailing Address - Country:US
Mailing Address - Phone:812-932-6251
Mailing Address - Fax:812-932-6386
Practice Address - Street 1:1198 STATE ROAD 46 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-9232
Practice Address - Country:US
Practice Address - Phone:812-932-6251
Practice Address - Fax:812-932-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201282270AMedicaid