=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487944294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE'S FAMILY PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2011
-----------------------------------------------------
Last Update Date | 08/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 S. WASHINGTON ST. SUITE 22
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-689-0200
-----------------------------------------------------
Fax | 812-689-0201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 S. WASHINGTON ST. SUITE 22
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-689-0200
-----------------------------------------------------
Fax | 812-689-0201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | BLAKE GILLMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-265-4699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 60006249A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------