Provider Demographics
NPI:1205883394
Name:STEWART'S PHARMACY, INC.
Entity type:Organization
Organization Name:STEWART'S PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-794-3001
Mailing Address - Street 1:57 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:IN
Mailing Address - Zip Code:47102-1303
Mailing Address - Country:US
Mailing Address - Phone:812-794-3001
Mailing Address - Fax:812-794-4007
Practice Address - Street 1:57 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:IN
Practice Address - Zip Code:47102-1303
Practice Address - Country:US
Practice Address - Phone:812-794-3001
Practice Address - Fax:812-794-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005878A332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60005878AOtherSTATE PHARMACY LICENSE #
IN26018757AOtherPHARMACIST LICENSE #
IN=========OtherTAX ID NUMBER
IN26018757AOtherPHARMACIST LICENSE #
IN60005878AOtherSTATE PHARMACY LICENSE #
IN5405020001Medicare NSC