Provider Demographics
NPI:1770606139
Name:APOTHECARY SHOPPE PHARMACY
Entity type:Organization
Organization Name:APOTHECARY SHOPPE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:360-479-4900
Mailing Address - Street 1:2500 CHERRY AVE
Mailing Address - Street 2:SUITE NUMBER 101
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4202
Mailing Address - Country:US
Mailing Address - Phone:360-479-4900
Mailing Address - Fax:360-373-0869
Practice Address - Street 1:2500 CHERRY AVE
Practice Address - Street 2:SUITE NUMBER 101
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4202
Practice Address - Country:US
Practice Address - Phone:360-479-4900
Practice Address - Fax:360-373-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000021583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6021901Medicaid
WA4902486OtherNABP NUMBER
WA4902486OtherNABP NUMBER
WA0516370001Medicare ID - Type Unspecified