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General NPI Number Information
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NPI Number | 1962753764
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Entity Type | Organization
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Legal Business Name | PILL BOX PHARMACY LLC
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 1329 S MAIN ST UNIT C
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City | SAPULPA
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State | OK
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Zip | 74066-5505
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Country | US
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Telephone | 918-512-6635
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Fax | 918-512-6638
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Provider Business Mailing Address
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Address Line | 1329 S MAIN ST UNIT C
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City | SAPULPA
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State | OK
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Zip | 74066-5500
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Country | US
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Telephone | 918-512-6635
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Fax | 918-512-6658
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Authorized Official
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Title or Position | OWNER/PIC
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Name | MELINDA KAY MAST
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Credential | PHARMD
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Telephone | 918-512-6635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11-6064
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License Number State | OK
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