=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760545222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PILLS IN PACKAGES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 03/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 249 W MADISON ST
-----------------------------------------------------
City | GIBSONBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43431-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-637-7441
-----------------------------------------------------
Fax | 419-637-7629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 249 W MADISON ST
-----------------------------------------------------
City | GIBSONBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43431-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-637-7441
-----------------------------------------------------
Fax | 419-637-7629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRES
-----------------------------------------------------
Name | MICHAEL WARREN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 419-637-7441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 021125050
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------