=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912503657
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH ANN GEMEINHART RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2020
-----------------------------------------------------
Last Update Date | 12/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 E 1100 N
-----------------------------------------------------
City | CHESTERTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46304-9697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-926-1420
-----------------------------------------------------
Fax | 219-395-1847
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 513 WINDRIDGE DR
-----------------------------------------------------
City | CHESTERTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46304-9394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-928-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26019013A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------