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

General Provider Information

NPI Number	:	1972451946
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	:

Provider Business Practice Location Address
First Line	:	6425 CROSS CREEK BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1720
Country	:	US
Telephone Number	:	260-702-9931
Fax Number	:	260-387-5367

Authorized Official
Title or Position	:	CEO
Name	:	BLAKE GILLMAN
Credential	:
Telephone Number	:	765-647-6251

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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