Provider Demographics
NPI:1841788429
Name:PILL BOX RX LLC
Entity Type:Organization
Organization Name:PILL BOX RX LLC
Other - Org Name:PILL BOX RX LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-928-7277
Mailing Address - Street 1:11042 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-8215
Mailing Address - Country:US
Mailing Address - Phone:718-928-7277
Mailing Address - Fax:718-928-7266
Practice Address - Street 1:11042 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8215
Practice Address - Country:US
Practice Address - Phone:718-928-7277
Practice Address - Fax:718-928-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
NY0364383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177456OtherPK
NYPENDINGMedicaid