Provider Demographics
NPI:1790076651
Name:APOTHACA, INC.
Entity Type:Organization
Organization Name:APOTHACA, INC.
Other - Org Name:PHUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:401-481-3001
Mailing Address - Street 1:17 COVENTRY SHOPPERS PARK
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5702
Mailing Address - Country:US
Mailing Address - Phone:401-481-3001
Mailing Address - Fax:401-633-6566
Practice Address - Street 1:17 COVENTRY SHOPPERS PARK
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5702
Practice Address - Country:US
Practice Address - Phone:401-481-3001
Practice Address - Fax:401-633-6566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHUSION RX, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPENDING3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy