Provider Demographics
NPI:1114984473
Name:SALEM APOTHECARY, INC
Entity Type:Organization
Organization Name:SALEM APOTHECARY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-883-4500
Mailing Address - Street 1:3 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2050
Mailing Address - Country:US
Mailing Address - Phone:812-883-4500
Mailing Address - Fax:812-883-1440
Practice Address - Street 1:3 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2050
Practice Address - Country:US
Practice Address - Phone:812-883-4500
Practice Address - Fax:812-883-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60003161332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100302600AMedicaid
IN300030797Medicaid