Provider Demographics
NPI:1184047987
Name:SPENCERPORT FAMILY APOTHECARY, LLC
Entity type:Organization
Organization Name:SPENCERPORT FAMILY APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHLADEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:585-349-3562
Mailing Address - Street 1:5017 W RIDGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1568
Mailing Address - Country:US
Mailing Address - Phone:585-349-3562
Mailing Address - Fax:585-349-3564
Practice Address - Street 1:5017 W RIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1568
Practice Address - Country:US
Practice Address - Phone:585-349-3562
Practice Address - Fax:585-349-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X, 3336S0011X
NY0326713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04044524Medicaid
2147657OtherPK