Provider Demographics
NPI:1689672669
Name:THE PILL BOX PHARMACY
Entity Type:Organization
Organization Name:THE PILL BOX PHARMACY
Other - Org Name:THE PILL BOX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-674-1625
Mailing Address - Street 1:1108 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-2112
Mailing Address - Country:US
Mailing Address - Phone:559-674-1625
Mailing Address - Fax:559-674-3109
Practice Address - Street 1:1108 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-2112
Practice Address - Country:US
Practice Address - Phone:559-674-1625
Practice Address - Fax:559-674-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA396873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000687OtherPK
CAPHA396870Medicaid