Provider Demographics
NPI:1093004533
Name:PEMBERTON APOTHECARY, LLC
Entity Type:Organization
Organization Name:PEMBERTON APOTHECARY, LLC
Other - Org Name:PEMBERTON APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SCHURY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-677-0707
Mailing Address - Street 1:1147 PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2529
Mailing Address - Country:US
Mailing Address - Phone:410-677-0707
Mailing Address - Fax:
Practice Address - Street 1:1306 S SALISBURY BLVD
Practice Address - Street 2:UNITS 9&10
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-6841
Practice Address - Country:US
Practice Address - Phone:410-677-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy