MEDICARE: GAIL M MINNICK RPH

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	183500000X	Pharmacist	26012807A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26012807A	OTHER	IN	STATE LICENSE

General Provider Information

NPI Number	:	1548458813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL M MINNICK RPH

Provider Business Mailing Address
First Line	:	939 VETERANS DR
Second Line	:	SUITE B
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-2602
Country	:	US
Telephone Number	:	812-352-9700
Fax Number	:	812-352-9702

Provider Business Practice Location Address
First Line	:	939 VETERANS DR
Second Line	:	SUITE B
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-2602
Country	:	US
Telephone Number	:	812-352-9700
Fax Number	:	812-352-9702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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Directions to “ GAIL M MINNICK RPH” Practice Location

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