Provider Demographics
NPI:1285189241
Name:APOLLO PHARMACY LLC
Entity Type:Organization
Organization Name:APOLLO PHARMACY LLC
Other - Org Name:APOLLO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, AO, PHCY MANAGER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-280-7020
Mailing Address - Street 1:16697 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8970
Mailing Address - Country:US
Mailing Address - Phone:303-280-7020
Mailing Address - Fax:303-803-4763
Practice Address - Street 1:16697 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80023-8970
Practice Address - Country:US
Practice Address - Phone:303-280-7020
Practice Address - Fax:303-803-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
COPDO16800001203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163611OtherPK