Provider Demographics
NPI:1578274106
Name:LUKE PILL LLC
Entity Type:Organization
Organization Name:LUKE PILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDAROUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-319-4033
Mailing Address - Street 1:113 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2168
Mailing Address - Country:US
Mailing Address - Phone:717-319-4033
Mailing Address - Fax:501-604-8009
Practice Address - Street 1:901 JOHN BARROW RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6503
Practice Address - Country:US
Practice Address - Phone:501-604-8008
Practice Address - Fax:501-604-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy