Provider Demographics
NPI:1760545222
Name:PILLS IN PACKAGES
Entity Type:Organization
Organization Name:PILLS IN PACKAGES
Other - Org Name:PILLS IN PACKAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-637-7441
Mailing Address - Street 1:249 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431-1319
Mailing Address - Country:US
Mailing Address - Phone:419-637-7441
Mailing Address - Fax:419-637-7629
Practice Address - Street 1:249 W MADISON ST
Practice Address - Street 2:
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431-1319
Practice Address - Country:US
Practice Address - Phone:419-637-7441
Practice Address - Fax:419-637-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0211250503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076520OtherPK
OH2132301Medicaid