Individual
GARY NEPHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2824 ELKHART RD, GOSHEN, IN 46526-1014
(574) 537-1111
Mailing address
1937 COUNTRY CIR S, NAPPANEE, IN 46550-8969
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26024001A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26024001A
INDIANA BOARD OF PHARMACY
IN
Enumeration date
07/24/2020
Last updated
02/08/2021
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