=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578558979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PILL BOX PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2005
-----------------------------------------------------
Last Update Date | 03/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2306 DUBOIS DR
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46580-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-267-4900
-----------------------------------------------------
Fax | 574-267-8028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2306 DUBOIS DR
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46580-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-267-4900
-----------------------------------------------------
Fax | 574-267-8028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GREGORY WINN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 574-267-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 60006367A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------