Provider Demographics
NPI:1528219318
Name:APOTHECA COMPOUNDING PHARMACY INC
Entity Type:Organization
Organization Name:APOTHECA COMPOUNDING PHARMACY INC
Other - Org Name:APOTHECA COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-226-1112
Mailing Address - Street 1:14602 HUEBER
Mailing Address - Street 2:STE 2602
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215
Mailing Address - Country:US
Mailing Address - Phone:210-226-1112
Mailing Address - Fax:210-226-1119
Practice Address - Street 1:14603 HUEBER RD
Practice Address - Street 2:STE 2602
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-226-1112
Practice Address - Fax:210-226-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX261533336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4550059OtherNCPDP PROVIDER IDENTIFICATION NUMBER