Provider Demographics
NPI:1518047224
Name:THE APOTHECARY SHOPPE PHARMACIES, LLC
Entity Type:Organization
Organization Name:THE APOTHECARY SHOPPE PHARMACIES, LLC
Other - Org Name:EASTLAND APOTHECARY SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-313-3677
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48641-1727
Mailing Address - Country:US
Mailing Address - Phone:800-313-3677
Mailing Address - Fax:989-631-2820
Practice Address - Street 1:1217 E FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2928
Practice Address - Country:US
Practice Address - Phone:231-947-9825
Practice Address - Fax:231-947-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010082043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2334857OtherNCPDP
MI502334857Medicaid
MI875438844Medicaid
MI540B812050OtherBCBS DME
MI4835800004Medicare NSC