Provider Demographics
NPI:1639616600
Name:APOTHECO PHARMACY SACRAMENTO LLC
Entity type:Organization
Organization Name:APOTHECO PHARMACY SACRAMENTO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-869-2820
Mailing Address - Street 1:788 MORRIS TPKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:973-869-2820
Mailing Address - Fax:973-869-2822
Practice Address - Street 1:9632 EMERALD OAK DR
Practice Address - Street 2:SUITE G
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2258
Practice Address - Country:US
Practice Address - Phone:916-509-9834
Practice Address - Fax:916-627-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CA554563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2619441Medicaid