Healthcare Provider Details

I. General information

NPI: 1134222029
Provider Name (Legal Business Name): WARSAW RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8406 RICHLANDS HIGHWAY
RICHLANDS NC
28574
US

IV. Provider business mailing address

PO BOX 295
RICHLANDS NC
28574-0295
US

V. Phone/Fax

Practice location:
  • Phone: 910-324-3164
  • Fax: 910-324-1834
Mailing address:
  • Phone: 910-324-3164
  • Fax: 910-324-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4753
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number4753
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELSEY GELDERMAN
Title or Position: CREDENTIALING
Credential:
Phone: 910-324-3164