Healthcare Provider Details

I. General information

NPI: 1619355294
Provider Name (Legal Business Name): NEPHEW PHARMACY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 WATERFALL DR
NAPPANEE IN
46550-8961
US

IV. Provider business mailing address

1953 WATERFALL DR
NAPPANEE IN
46550-8961
US

V. Phone/Fax

Practice location:
  • Phone: 574-773-2404
  • Fax: 574-773-2401
Mailing address:
  • Phone: 574-773-2404
  • Fax: 574-773-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006498A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GARY NEPHEW
Title or Position: PRESIDENT/OWNER/PIC/AO
Credential: RPH
Phone: 574-286-2259