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Provider Information for 1730421975


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PILLS LLC

Other Names:  
Doing Business As: 
GRAND PHARMACY

Organization Subpart: NO

NPI: 1730421975
Last Updated: 2016-08-26
Certification Date:

Details

NameValue
NPI1730421975
Enumeration Date2013-03-26
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: MARK VOGLER RPh
Title: Member
Phone: 8066543530
Mailing Address PO BOX 10003
AMARILLO, TX 79116-0003
United States

Phone: 806-654-3530 | Fax:
 
Primary Practice Address 3500 NE 24TH AVE
AMARILLO, TX 79107-6920
United States

Phone: 806-654-3530 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDTX146792
MEDICAIDTX334909401
MEDICAIDTX334909402
Other (non-Medicare)TX356013Novitas
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies TX28600
Yes 3336C0003X - Pharmacy - Community/Retail Pharmacy