Provider Demographics
NPI:1114423365
Name:APOTHECO PHARMACY TROY LLC
Entity Type:Organization
Organization Name:APOTHECO PHARMACY TROY LLC
Other - Org Name:MODERN HEALTH PHARMACY OF BIRMINGHAM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-869-2820
Mailing Address - Street 1:2924 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7031
Mailing Address - Country:US
Mailing Address - Phone:248-850-1376
Mailing Address - Fax:248-850-1559
Practice Address - Street 1:2924 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7031
Practice Address - Country:US
Practice Address - Phone:248-850-1376
Practice Address - Fax:248-850-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177468OtherPK