Healthcare Provider Details

I. General information

NPI: 1295824977
Provider Name (Legal Business Name): YOUR FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N KRINGLE PL
SANTA CLAUS IN
47579-6153
US

IV. Provider business mailing address

PO BOX 188
SANTA CLAUS IN
47579-0188
US

V. Phone/Fax

Practice location:
  • Phone: 812-937-2682
  • Fax: 812-937-2843
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60005286A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICOLE TURNER
Title or Position: MNGING PART
Credential: RPH
Phone: 812-937-2682