Provider Demographics
NPI:1720143159
Name:PHILS PILLS INC
Entity Type:Organization
Organization Name:PHILS PILLS INC
Other - Org Name:PHILS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-265-6868
Mailing Address - Street 1:5510 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6545
Mailing Address - Country:US
Mailing Address - Phone:505-265-6868
Mailing Address - Fax:505-256-9196
Practice Address - Street 1:5510 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6545
Practice Address - Country:US
Practice Address - Phone:505-265-6868
Practice Address - Fax:505-256-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NMPH000039583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM63818Medicaid
2057607OtherPK
2057607OtherPK