Provider Demographics
NPI:1548281504
Name:PILL BOX DRIVE IN PHARMACY INC
Entity type:Organization
Organization Name:PILL BOX DRIVE IN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MACGILAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:443-469-8972
Mailing Address - Street 1:210 POSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-1854
Mailing Address - Country:US
Mailing Address - Phone:254-675-8659
Mailing Address - Fax:254-675-6745
Practice Address - Street 1:210 POSEY AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1854
Practice Address - Country:US
Practice Address - Phone:254-675-8659
Practice Address - Fax:254-675-6745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
TX252343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098992OtherPK
TX148600Medicaid
TX145467Medicaid