Organization Active NPI

Family Pharmacy, Inc.

  • Pharmacy
  • Bicknell, IN
National Provider Identifier
1114088911
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
60002628A Issued in IN
Legal business name
FAMILY PHARMACY, INC.
Practice address
508 W 11TH St
Bicknell, IN 47512-9626
Phone
(812) 735-4444
Fax
(812) 735-3017
NPI assigned
Dec 13, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Stanley D Deweese, RPHNPI 1255933941
Title
President
Phone
(812) 735-4444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 60002628A IN
Nursing Facility Supplies (DME) 332BN1400X 60002628A IN
Pharmacy 333600000X 60002628A IN Primary

Addresses

Primary practice location

508 W 11TH St
Bicknell, IN 47512-9626

Mailing address

508 W 11TH St
Bicknell, IN 47512-9626
Phone (812) 735-4444

Other identifiers 3

IdentifierTypeStateIssuer
000000097231OtherINANTHEM BLUE DME NUMBER
1519454OtherINNABP
000000216711OtherINANTHEM BLUE ORTH & PROS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930012508 IN DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 8628195138 Practice locations: Bicknell, IN
O20181203000664 IN Part B Supplier - Mass Immunization (Roster Biller Only) 8628195138 Practice locations: Bicknell, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0953364Family Pharmacy508 West Eleventh St, Bicknell, IN 47512Certificate of waiverMay 25, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Family Pharmacy Inc508 W 11TH St, Bicknell, IN 47512-9626(812) 735-4444 Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Locations

508 W 11th St
Bicknell, IN 47512
Phone (812) 735-4444

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1114088911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 W 11TH ST",
            "city": "BICKNELL",
            "state": "IN",
            "postal_code": "475129626",
            "telephone_number": "812-735-4444",
            "fax_number": "812-735-3017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 W 11TH ST",
            "city": "BICKNELL",
            "state": "IN",
            "postal_code": "475129626",
            "telephone_number": "812-735-4444",
            "fax_number": "812-735-3017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "DEWEESE",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-735-4444",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "60002628A",
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "IN",
            "license": "60002628A",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IN",
            "license": "60002628A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE DME NUMBER",
            "identifier": "000000097231",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1519454",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE ORTH & PROS",
            "identifier": "000000216711",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bicknell, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.