Healthcare Provider Details

I. General information

NPI: 1114988532
Provider Name (Legal Business Name): PILL MILL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 MAIN STREET
MARGARETVILLE NY
12455-0350
US

IV. Provider business mailing address

PO BOX 350 778 MAIN STREET
MARGARETVILLE NY
12455-0350
US

V. Phone/Fax

Practice location:
  • Phone: 845-586-4212
  • Fax: 845-586-3140
Mailing address:
  • Phone: 845-586-4212
  • Fax: 845-586-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number013235
License Number StateNY

VIII. Authorized Official

Name: FREDERICK G MILLER
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 845-586-4212