Provider Demographics
NPI:1740808625
Name:BIGBOX PHARMACY UNLIMITED LLC
Entity type:Organization
Organization Name:BIGBOX PHARMACY UNLIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-954-5454
Mailing Address - Street 1:509 E CHESTNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-2031
Mailing Address - Country:US
Mailing Address - Phone:580-688-2257
Mailing Address - Fax:580-688-2288
Practice Address - Street 1:509 E CHESTNUT ST STE B
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-2031
Practice Address - Country:US
Practice Address - Phone:580-688-2257
Practice Address - Fax:580-688-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64569OtherSTATE LICENSE (PERSONAL)