Provider Demographics
NPI:1659764181
Name:APOLLO PHARMACY OF GAITHERSBURG, INC.
Entity Type:Organization
Organization Name:APOLLO PHARMACY OF GAITHERSBURG, INC.
Other - Org Name:THE VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:UTKARSH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-912-7784
Mailing Address - Street 1:22492 CASTLE OAK ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-5352
Mailing Address - Country:US
Mailing Address - Phone:240-912-7784
Mailing Address - Fax:240-912-7764
Practice Address - Street 1:9999 STEDWICK ROAD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-3709
Practice Address - Country:US
Practice Address - Phone:240-912-7784
Practice Address - Fax:240-912-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP066463336C0003X
MDP078963336C0003X, 3336C0004X, 3336S0011X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151079OtherPK