MEDICARE: HERBST APOTHECARY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	60005692A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2024592	OTHER		PK

General Provider Information

NPI Number	:	1740272053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERBST APOTHECARY INC

Provider Business Mailing Address
First Line	:	710 W MAIN ST
Second Line	:
City	:	GREENTOWN
State	:	IN
Zip	:	46936-1045
Country	:	US
Telephone Number	:	765-628-3446
Fax Number	:	765-628-2639

Provider Business Practice Location Address
First Line	:	710 W MAIN ST
Second Line	:
City	:	GREENTOWN
State	:	IN
Zip	:	46936-1045
Country	:	US
Telephone Number	:	765-628-3446
Fax Number	:	765-628-2639

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HEIDI TANNER
Credential	:	RPH
Telephone Number	:	765-457-1191

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	03/09/2024

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Directions to “HERBST APOTHECARY INC ” Practice Location

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