Provider Demographics
NPI:1225087083
Name:APOTHECARY INC
Entity Type:Organization
Organization Name:APOTHECARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-782-5500
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:DOERUN
Mailing Address - State:GA
Mailing Address - Zip Code:31744
Mailing Address - Country:US
Mailing Address - Phone:229-782-5500
Mailing Address - Fax:229-782-5602
Practice Address - Street 1:227 W BROAD AVE
Practice Address - Street 2:
Practice Address - City:DOERUN
Practice Address - State:GA
Practice Address - Zip Code:31744-4260
Practice Address - Country:US
Practice Address - Phone:229-782-5500
Practice Address - Fax:229-782-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0065873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2015045OtherPK
GA00148343AMedicaid
GA00148343AMedicaid