Provider Demographics
NPI:1205348356
Name:TNT APOTHECARY LLC
Entity type:Organization
Organization Name:TNT APOTHECARY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GILL
Authorized Official - Last Name:WADSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-786-6211
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:ID
Mailing Address - Zip Code:83355-0487
Mailing Address - Country:US
Mailing Address - Phone:208-536-5761
Mailing Address - Fax:208-536-5852
Practice Address - Street 1:30 IDAHO AVE
Practice Address - Street 2:
Practice Address - City:GLENNS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83623
Practice Address - Country:US
Practice Address - Phone:208-536-5761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TNT APOTHECARY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy