Provider Demographics
NPI:1053990424
Name:PILLPACK LLC
Entity type:Organization
Organization Name:PILLPACK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VIE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-745-5725
Mailing Address - Street 1:1820 S SILVERSTONE WAY
Mailing Address - Street 2:SUITES 200 & 300
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:855-745-5725
Mailing Address - Fax:603-935-9108
Practice Address - Street 1:1820 S SILVERSTONE WAY
Practice Address - Street 2:SUITES 200 & 300
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:855-745-5725
Practice Address - Fax:603-935-9108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PILLPACK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-05
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy