Provider Demographics
NPI:1457772238
Name:APOTHECARY ARTS, L.L.C.
Entity Type:Organization
Organization Name:APOTHECARY ARTS, L.L.C.
Other - Org Name:APOTHECARY ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-396-1812
Mailing Address - Street 1:214 EXPO CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-9496
Mailing Address - Country:US
Mailing Address - Phone:318-509-8797
Mailing Address - Fax:318-654-7916
Practice Address - Street 1:214 EXPO CIR STE 2
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-9497
Practice Address - Country:US
Practice Address - Phone:318-509-8797
Practice Address - Fax:318-654-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67983336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143537OtherPK