Provider Demographics
NPI:1912237272
Name:ALPINE APOTHECARY, LLC
Entity Type:Organization
Organization Name:ALPINE APOTHECARY, LLC
Other - Org Name:ALPINE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARESTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-615-0070
Mailing Address - Street 1:1675 REDSTONE CENTER DR
Mailing Address - Street 2:STE 125
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7608
Mailing Address - Country:US
Mailing Address - Phone:435-615-0070
Mailing Address - Fax:435-615-7067
Practice Address - Street 1:1675 REDSTONE CENTER DR STE 125
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7617
Practice Address - Country:US
Practice Address - Phone:435-615-0070
Practice Address - Fax:435-615-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-10
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9066325-17033336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124975OtherPK