Provider Demographics
NPI:1033938121
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 1:330 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2604
Mailing Address - Country:US
Mailing Address - Phone:765-825-6251
Mailing Address - Fax:
Practice Address - Street 1:330 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2604
Practice Address - Country:US
Practice Address - Phone:765-825-6251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300027007Medicaid