Healthcare Provider Details

I. General information

NPI: 1801854047
Provider Name (Legal Business Name): GEORGE'S FAMILY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5543 E WASHINGTON ST
INDIANAPOLIS IN
46219-6448
US

IV. Provider business mailing address

5543 E WASHINGTON ST
INDIANAPOLIS IN
46219-6448
US

V. Phone/Fax

Practice location:
  • Phone: 317-359-8278
  • Fax: 317-359-3400
Mailing address:
  • Phone: 317-359-8278
  • Fax: 317-359-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60000438A
License Number StateIN

VIII. Authorized Official

Name: BLAKE CLY GILLMAN
Title or Position: OWNER/CEO
Credential:
Phone: 765-265-4699