Provider Demographics
NPI:1255317772
Name:APOTHECARY SERVICES INC
Entity Type:Organization
Organization Name:APOTHECARY SERVICES INC
Other - Org Name:LOW COST MOBILITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVESAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-608-6143
Mailing Address - Street 1:19 E AMES ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1705
Mailing Address - Country:US
Mailing Address - Phone:765-608-6143
Mailing Address - Fax:765-608-6144
Practice Address - Street 1:19 E AMES ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1705
Practice Address - Country:US
Practice Address - Phone:765-649-1255
Practice Address - Fax:765-649-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097359OtherANTHEM
IN100172370AMedicaid
IN0539940001Medicare NSC