Provider Demographics
NPI:1619355294
Name:NEPHEW PHARMACY PC
Entity Type:Organization
Organization Name:NEPHEW PHARMACY PC
Other - Org Name:NEPHEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEPHEW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:574-286-2259
Mailing Address - Street 1:1953 WATERFALL DR
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-8961
Mailing Address - Country:US
Mailing Address - Phone:574-773-2404
Mailing Address - Fax:574-773-2401
Practice Address - Street 1:1953 WATERFALL DR
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-8961
Practice Address - Country:US
Practice Address - Phone:574-773-2404
Practice Address - Fax:574-773-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006498A3336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151965OtherPK