Provider Demographics
NPI:1811313216
Name:JILL'S GENUINE CARE PHARMACY, LLC
Entity type:Organization
Organization Name:JILL'S GENUINE CARE PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTIGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-987-5940
Mailing Address - Street 1:23603 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-6401
Mailing Address - Country:US
Mailing Address - Phone:248-987-5940
Mailing Address - Fax:248-987-5941
Practice Address - Street 1:23603 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-6401
Practice Address - Country:US
Practice Address - Phone:248-987-5940
Practice Address - Fax:248-987-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144597OtherPK
MI5301013135Medicaid