Provider Demographics
NPI:1578050423
Name:APOTHECA LLC
Entity Type:Organization
Organization Name:APOTHECA LLC
Other - Org Name:APOTHECA AT RIDGWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-728-0488
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-1299
Mailing Address - Country:US
Mailing Address - Phone:970-626-4432
Mailing Address - Fax:970-626-4032
Practice Address - Street 1:171 N. CORA ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432
Practice Address - Country:US
Practice Address - Phone:970-626-4432
Practice Address - Fax:970-626-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
COOO.00006113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177724OtherPK