Provider Demographics
NPI:1639524549
Name:ANNIE'S APOTHECARY
Entity Type:Organization
Organization Name:ANNIE'S APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-981-4774
Mailing Address - Street 1:31007 INTERSTATE 10 W
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9264
Mailing Address - Country:US
Mailing Address - Phone:830-981-4774
Mailing Address - Fax:
Practice Address - Street 1:31007 INTERSTATE 10 W
Practice Address - Street 2:SUITE 108
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9264
Practice Address - Country:US
Practice Address - Phone:830-981-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty