Provider Demographics
NPI:1023064128
Name:PILL STAT RX LLC
Entity type:Organization
Organization Name:PILL STAT RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:216-369-2200
Mailing Address - Street 1:805 BEACHWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-7788
Mailing Address - Country:US
Mailing Address - Phone:317-829-0550
Mailing Address - Fax:317-829-0540
Practice Address - Street 1:805 BEACHWAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-7788
Practice Address - Country:US
Practice Address - Phone:317-829-0550
Practice Address - Fax:317-829-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
IN60006164A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2024883OtherPK
IN100292670AMedicaid
5581600001Medicare NSC