Provider Demographics
NPI:1801083449
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:252-943-8688
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:252-943-8688
Mailing Address - Fax:
Practice Address - Street 1:107 S PINE ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-1924
Practice Address - Country:US
Practice Address - Phone:910-293-4334
Practice Address - Fax:910-293-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09914333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150557OtherPK
NC0315483Medicaid