Provider Demographics
NPI:1801854047
Name:GEORGE'S FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:GEORGE'S FAMILY PHARMACY, INC.
Other - Org Name:GEORGE'S PHARMACY EAST SIDE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:CLY
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-265-4699
Mailing Address - Street 1:5543 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6448
Mailing Address - Country:US
Mailing Address - Phone:317-359-8278
Mailing Address - Fax:317-359-3400
Practice Address - Street 1:5543 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6448
Practice Address - Country:US
Practice Address - Phone:317-359-8278
Practice Address - Fax:317-359-3400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE'S PHARMACY EAST SIDE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60000438A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100291870AMedicaid
IN0237120001Medicare ID - Type UnspecifiedPROVIDER # MEDICARE