Provider Demographics
NPI:1619014453
Name:WARSAW RX LLC
Entity type:Organization
Organization Name:WARSAW RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-324-3164
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-0295
Mailing Address - Country:US
Mailing Address - Phone:910-324-3164
Mailing Address - Fax:910-324-1834
Practice Address - Street 1:8406 RICHLANDS HWY
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574
Practice Address - Country:US
Practice Address - Phone:910-324-3164
Practice Address - Fax:910-324-1834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARSAW RX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC047533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0675272Medicaid
2068116OtherPK
NC7701290Medicaid
0468430001Medicare NSC