Healthcare Provider Details

I. General information

NPI: 1063872455
Provider Name (Legal Business Name): THE PILL BOX PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BRIDGE BLVD SW STE B2
ALBUQUERQUE NM
87105-3765
US

IV. Provider business mailing address

1010 BRIDGE BLVD SW STE B2
ALBUQUERQUE NM
87105-3765
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-4106
  • Fax: 505-207-5729
Mailing address:
  • Phone: 505-508-4106
  • Fax: 505-207-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00004182
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMY LOVELL
Title or Position: OPERATIONS ADMINISTRATION
Credential:
Phone: 505-573-9684