Healthcare Provider Details

I. General information

NPI: 1528016136
Provider Name (Legal Business Name): LINTON FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 A ST NW
LINTON IN
47441-1801
US

IV. Provider business mailing address

60 A ST NW
LINTON IN
47441-1801
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-1978
  • Fax: 812-847-1985
Mailing address:
  • Phone: 812-847-1978
  • Fax: 812-847-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60005942A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DORIS
Title or Position: OWNER,PRES,PIC,AO
Credential: RPH
Phone: 812-847-1978