Provider Demographics
NPI:1316029184
Name:TNT APOTHECARY LLC
Entity Type:Organization
Organization Name:TNT APOTHECARY LLC
Other - Org Name:WENDELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WADSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-536-5761
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:ID
Mailing Address - Zip Code:83355-0487
Mailing Address - Country:US
Mailing Address - Phone:208-536-5761
Mailing Address - Fax:208-536-5852
Practice Address - Street 1:280 S IDAHO ST
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:ID
Practice Address - Zip Code:83355-5200
Practice Address - Country:US
Practice Address - Phone:208-536-5761
Practice Address - Fax:208-536-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2335CP3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120704OtherPK
2120704OtherPK