Provider Demographics
NPI:1932658614
Name:DIABETIC APOTHECARY LLC
Entity Type:Organization
Organization Name:DIABETIC APOTHECARY LLC
Other - Org Name:DIABETIC APOTHECARY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERTIONS MANAGER/AO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-371-6122
Mailing Address - Street 1:6191 ORANGE DR
Mailing Address - Street 2:#6177 N
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3449
Mailing Address - Country:US
Mailing Address - Phone:602-775-5370
Mailing Address - Fax:602-775-5371
Practice Address - Street 1:15640 N 28TH DR
Practice Address - Street 2:SUITE PHARMACY
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4059
Practice Address - Country:US
Practice Address - Phone:602-775-5370
Practice Address - Fax:602-775-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0069693336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164274OtherPK