Provider Demographics
NPI:1790099653
Name:PILLERS SUPER DRUG INC
Entity Type:Organization
Organization Name:PILLERS SUPER DRUG INC
Other - Org Name:MILLERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-513-4895
Mailing Address - Street 1:102 E DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432-2043
Mailing Address - Country:US
Mailing Address - Phone:903-395-2161
Mailing Address - Fax:903-300-3701
Practice Address - Street 1:102 E DALLAS AVE
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75432-2043
Practice Address - Country:US
Practice Address - Phone:903-395-2161
Practice Address - Fax:903-300-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX270053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126153OtherPK
TX146231Medicaid