Provider Demographics
NPI:1760626055
Name:FAMILY APOTHECARY LLC
Entity Type:Organization
Organization Name:FAMILY APOTHECARY LLC
Other - Org Name:THE FAMILY APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISANTHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-934-2070
Mailing Address - Street 1:10441 PERRY HWY
Mailing Address - Street 2:SUITE 17
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10441 PERRY HWY
Practice Address - Street 2:SUITE 17
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9292
Practice Address - Country:US
Practice Address - Phone:724-934-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4817903336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3992016OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA1022628480001Medicaid