Healthcare Provider Details

I. General information

NPI: 1174694848
Provider Name (Legal Business Name): GWINNS DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MADISON AVE
ANDERSON IN
46016
US

IV. Provider business mailing address

505 MADISON AVE
ANDERSON IN
46016
US

V. Phone/Fax

Practice location:
  • Phone: 765-643-3716
  • Fax: 765-643-0265
Mailing address:
  • Phone: 765-643-3716
  • Fax: 765-643-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60000869A
License Number StateIN

VIII. Authorized Official

Name: MR. JAMES C HOFFMAN
Title or Position: OWNER
Credential: RPH
Phone: 765-643-3716