Provider Demographics
NPI:1710718697
Name:PILLPACK LLC
Entity type:Organization
Organization Name:PILLPACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RIOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-745-5725
Mailing Address - Street 1:29753 S. WIXOM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393
Mailing Address - Country:US
Mailing Address - Phone:855-745-5725
Mailing Address - Fax:
Practice Address - Street 1:29753 S. WIXOM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393
Practice Address - Country:US
Practice Address - Phone:855-745-5725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PILLPACK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy