Provider Demographics
NPI:1558953265
Name:THE APOTHECARY AT DMH, LLC
Entity Type:Organization
Organization Name:THE APOTHECARY AT DMH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-494-3535
Mailing Address - Street 1:PO BOX 2177
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34265-2177
Mailing Address - Country:US
Mailing Address - Phone:863-494-3535
Mailing Address - Fax:
Practice Address - Street 1:900 N ROBERT AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8712
Practice Address - Country:US
Practice Address - Phone:863-494-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy