Healthcare Provider Details

I. General information

NPI: 1801083449
Provider Name (Legal Business Name): WARSAW RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S PINE ST
WARSAW NC
28398-1924
US

IV. Provider business mailing address

PO BOX 295
RICHLANDS NC
28574-0295
US

V. Phone/Fax

Practice location:
  • Phone: 910-293-4334
  • Fax: 910-293-4397
Mailing address:
  • Phone: 252-943-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number09914
License Number StateNC

VIII. Authorized Official

Name: KELSEY GELDERMAN
Title or Position: CREDENTIALING
Credential:
Phone: 252-943-8688