Provider Demographics
NPI:1609953611
Name:THE DRUG STORE INC
Entity Type:Organization
Organization Name:THE DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FREIBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:812-923-8845
Mailing Address - Street 1:1044 NORTH LUTHER RD
Mailing Address - Street 2:PO BOX 456
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9122
Mailing Address - Country:US
Mailing Address - Phone:812-923-8845
Mailing Address - Fax:812-923-9969
Practice Address - Street 1:1044 NORTH LUTHER RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9122
Practice Address - Country:US
Practice Address - Phone:812-923-8845
Practice Address - Fax:812-923-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26011641A183500000X
IN600023723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1517551OtherNCPDP