NPIMap

Organization Active NPI

Pauls Pharmacy Inc

  • Community/Retail Pharmacy
  • Evansville, IN
National Provider Identifier
1083615603
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006286A Issued in IN
Legal business name
PAULS PHARMACY INC
Doing business as
PAUL'S PHARMACY
Practice address
4701 University Dr
Evansville, IN 47712-6583
Phone
(812) 425-4364
Fax
(812) 425-5399
NPI assigned
Aug 4, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacob Mayer
Title
President, Owner
Phone
(812) 425-4364

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 60006286A IN Primary
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

4701 University Dr
Evansville, IN 47712-6583

Mailing address

4701 University Dr
Evansville, IN 47712-6583
Phone (812) 425-4364

Other identifiers 2

IdentifierTypeStateIssuer
100301850MedicaidIN
2024003OtherPK

Other names 1

  • PAUL'S PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050418000912 IN Part B Supplier - Pharmacy 7911945381 Practice locations: Evansville, IN
O20110819000501 IN DME Supplier - Pharmacy 7911945381 Practice locations: Evansville, IN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pauls Pharmacy Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4701 University Dr
Evansville, IN 47712
Phone (812) 425-4364

2345 W Franklin St
Evansville, IN 47712
Phone (812) 401-0500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756339200000",
    "number": "1083615603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 UNIVERSITY DR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477126583",
            "telephone_number": "812-425-4364",
            "fax_number": "812-425-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 UNIVERSITY DR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477126583",
            "telephone_number": "812-425-4364",
            "fax_number": "812-425-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAULS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-04",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-14",
        "status": "A",
        "authorized_official_last_name": "MAYER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT, OWNER",
        "authorized_official_telephone_number": "812-425-4364"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006286A",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100301850",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2024003",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAUL'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.