Provider Demographics
NPI:1720165467
Name:DANMAR FAMILY PHARMACY INC
Entity type:Organization
Organization Name:DANMAR FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HABERMEL III
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-883-2102
Mailing Address - Street 1:47 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2025
Mailing Address - Country:US
Mailing Address - Phone:812-883-2102
Mailing Address - Fax:812-883-2993
Practice Address - Street 1:47 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2025
Practice Address - Country:US
Practice Address - Phone:812-883-2102
Practice Address - Fax:812-883-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004288A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1530523OtherNABP
IN100302630AMedicaid
IN1530523OtherNCPDP
IN1530523OtherNCPDP
IN100302630AMedicaid