Provider Demographics
NPI:1396381679
Name:APOTHECARY ASSOCIATES LLC
Entity Type:Organization
Organization Name:APOTHECARY ASSOCIATES LLC
Other - Org Name:ROOF DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROOF
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-302-6500
Mailing Address - Street 1:PO BOX 2090
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-8090
Mailing Address - Country:US
Mailing Address - Phone:580-302-6500
Mailing Address - Fax:580-302-6501
Practice Address - Street 1:1315 N WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2443
Practice Address - Country:US
Practice Address - Phone:580-302-6500
Practice Address - Fax:580-302-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200886010AMedicaid
OK28-8578OtherOKLAHOMA STATE BOARD OF PHARMACY
OK71705OtherOKLAHOMA BUREAU OF NARCOTICS AND DANGEROUS DRUGS