Provider Demographics
NPI:1821682295
Name:ADELAIDE APOTHECARY, LLC
Entity Type:Organization
Organization Name:ADELAIDE APOTHECARY, LLC
Other - Org Name:ADELAIDE APOTHECARY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-909-8520
Mailing Address - Street 1:160 MOORE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2970
Mailing Address - Country:US
Mailing Address - Phone:859-909-8520
Mailing Address - Fax:
Practice Address - Street 1:160 MOORE DR STE 105
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2970
Practice Address - Country:US
Practice Address - Phone:859-909-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAYNE PHARMA COMMERCIAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-25
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy