MEDICARE: GEORGE'S FAMILY PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	60003113A	IN
2	333600000X	Pharmacy	60003113A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1509794	OTHER		NABP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000097297	OTHER		ANTHEM PROV ID NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P00110488	OTHER	IN	RAILROAD

General Provider Information

NPI Number	:	1053314021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE'S FAMILY PHARMACY INC

Provider Business Mailing Address
First Line	:	480 MAIN ST
Second Line	:
City	:	BROOKVILLE
State	:	IN
Zip	:	47012-1406
Country	:	US
Telephone Number	:	765-647-6251
Fax Number	:	765-647-6386

Provider Business Practice Location Address
First Line	:	480 MAIN ST
Second Line	:
City	:	BROOKVILLE
State	:	IN
Zip	:	47012-1406
Country	:	US
Telephone Number	:	765-647-6251
Fax Number	:	765-647-6386

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. GEORGE GILLMAN
Credential	:	RPH
Telephone Number	:	765-647-6251

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/13/2008

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Directions to “GEORGE'S FAMILY PHARMACY INC ” Practice Location

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