Provider Demographics
NPI:1326056482
Name:APOTHECARY ENTERPRISES, LTD.
Entity Type:Organization
Organization Name:APOTHECARY ENTERPRISES, LTD.
Other - Org Name:FAMILY DRUGCENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:LITTLETON
Authorized Official - Last Name:ZEIGLER
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:276-395-2257
Mailing Address - Street 1:P.O. BOX 1828
Mailing Address - Street 2:517 FRONT STREET W.
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-3607
Mailing Address - Country:US
Mailing Address - Phone:276-395-2257
Mailing Address - Fax:276-395-3526
Practice Address - Street 1:517 FRONT ST WEST
Practice Address - Street 2:MARTY SHOPPING CENTER
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-3607
Practice Address - Country:US
Practice Address - Phone:276-395-2257
Practice Address - Fax:276-395-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010018963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4817512OtherNABP
VA8513457Medicaid
4817512OtherNABP