Provider Demographics
NPI:1114988532
Name:PILL MILL INC.
Entity Type:Organization
Organization Name:PILL MILL INC.
Other - Org Name:MILLERS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-586-4212
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:778 MAIN STREET
Mailing Address - City:MARGARETVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12455-0350
Mailing Address - Country:US
Mailing Address - Phone:845-586-4212
Mailing Address - Fax:845-586-3140
Practice Address - Street 1:778 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455-0350
Practice Address - Country:US
Practice Address - Phone:845-586-4212
Practice Address - Fax:845-586-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013235333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013235OtherSTATE PHARMACY LICENSE
NY00888353Medicaid
3335759OtherNABP
3335759OtherNABP