Healthcare Provider Details

I. General information

NPI: 1710718697
Provider Name (Legal Business Name): PILLPACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29753 S. WIXOM RD SUITE 100
WIXOM MI
48393
US

IV. Provider business mailing address

29753 S. WIXOM RD SUITE 100
WIXOM MI
48393
US

V. Phone/Fax

Practice location:
  • Phone: 855-745-5725
  • Fax:
Mailing address:
  • Phone: 855-745-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TANVI JAYANTI PATEL
Title or Position: VICE PRESIDENT
Credential:
Phone: 855-745-5725