Provider Demographics
NPI:1811169725
Name:MAURER'S APOTHECARY
Entity type:Organization
Organization Name:MAURER'S APOTHECARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CCN, DNM
Authorized Official - Phone:812-448-2190
Mailing Address - Street 1:555 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7729
Mailing Address - Country:US
Mailing Address - Phone:812-448-2190
Mailing Address - Fax:812-448-2190
Practice Address - Street 1:555 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-7729
Practice Address - Country:US
Practice Address - Phone:812-448-2190
Practice Address - Fax:812-448-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60002978A332BX2000X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0456470001Medicare NSC