=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215963962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRETT PHARMACARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 S RANDOLPH ST
-----------------------------------------------------
City | GARRETT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46738-1468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-357-4022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 S RANDOLPH ST
-----------------------------------------------------
City | GARRETT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46738-1468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-357-4022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. THOMAS J FEICHTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 260-969-3196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 60005753A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------