Provider Demographics
NPI:1972979169
Name:ANNICE APOTHECARY & DELI
Entity Type:Organization
Organization Name:ANNICE APOTHECARY & DELI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUKHANA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:602-332-1123
Mailing Address - Street 1:4131 MAIN ST
Mailing Address - Street 2:SUITE NUMBER 2
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4131 MAIN ST
Practice Address - Street 2:SUITE NUMBER 2
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2780
Practice Address - Country:US
Practice Address - Phone:602-332-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty