Provider Demographics
NPI:1093955544
Name:APOTHECARE LLC
Entity Type:Organization
Organization Name:APOTHECARE LLC
Other - Org Name:APOTHECARE,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-384-3105
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-0910
Mailing Address - Country:US
Mailing Address - Phone:601-384-3105
Mailing Address - Fax:601-384-3108
Practice Address - Street 1:82 MAIN ST W
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653-9320
Practice Address - Country:US
Practice Address - Phone:601-384-3105
Practice Address - Fax:601-384-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08046/02.3333600000X
3336C0003X, 3336C0004X
LAPHY.007269-NR3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06070017Medicaid
LA2204408Medicaid
2119623OtherPK