Provider Demographics
NPI:1851403851
Name:ZAK APOTHECARIUM LLC
Entity Type:Organization
Organization Name:ZAK APOTHECARIUM LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MISIASZEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:603-893-4930
Mailing Address - Street 1:15 ERMER RD
Mailing Address - Street 2:SUITES 109 AND 109A
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 ERMER RD
Practice Address - Street 2:SUITES 109 AND 109A
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1271
Practice Address - Country:US
Practice Address - Phone:603-893-4930
Practice Address - Fax:603-890-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0601333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008945Medicaid
3004417OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3004417OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NHBT7245524OtherDEA #