=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639966583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PILLPACK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 ENTERPRISE PARKWAY STE 100
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-745-5725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 ENTERPRISE PKWY STE 100
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-6254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-745-5725
-----------------------------------------------------
Fax | 603-935-9108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | TANVI JAYANTI PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 855-745-5725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336M0002X
-----------------------------------------------------
Taxonomy Name | Mail Order Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------