Provider Demographics
NPI:1558194696
Name:PILLCRAFT PHARMACY
Entity type:Organization
Organization Name:PILLCRAFT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:562-533-8990
Mailing Address - Street 1:4227 S MAIN ST STE 14
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5309
Mailing Address - Country:US
Mailing Address - Phone:832-615-3662
Mailing Address - Fax:832-478-1256
Practice Address - Street 1:4227 S MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5309
Practice Address - Country:US
Practice Address - Phone:832-615-3662
Practice Address - Fax:832-478-1256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PILLCRAFT PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-23
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy