Provider Demographics
NPI:1619962511
Name:PROFESSIONAL APOTHECARY INC.
Entity Type:Organization
Organization Name:PROFESSIONAL APOTHECARY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-362-8328
Mailing Address - Street 1:210 NORTH ST W
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2083
Mailing Address - Country:US
Mailing Address - Phone:256-362-8328
Mailing Address - Fax:256-362-8361
Practice Address - Street 1:210 NORTH ST W
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2083
Practice Address - Country:US
Practice Address - Phone:256-362-8328
Practice Address - Fax:256-362-8361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL108150333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100000263Medicaid
AL100000263Medicaid
ALAPO463997OtherDEA