Provider Demographics
NPI:1134222029
Name:WARSAW RX LLC
Entity type:Organization
Organization Name:WARSAW RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-324-3164
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-0295
Mailing Address - Country:US
Mailing Address - Phone:910-324-3164
Mailing Address - Fax:910-324-1834
Practice Address - Street 1:8406 RICHLANDS HIGHWAY
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574
Practice Address - Country:US
Practice Address - Phone:910-324-3164
Practice Address - Fax:910-324-1834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARSAW RX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4753332BP3500X, 332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04797OtherBCBS PROVIDER NUMBER
NC0675272Medicaid
NC7701290Medicaid
NC04797OtherBCBS PROVIDER NUMBER