Provider Demographics
NPI:1932548740
Name:ATLANTIC APOTHECARY MIDDLETOWN INC
Entity Type:Organization
Organization Name:ATLANTIC APOTHECARY MIDDLETOWN INC
Other - Org Name:ATLANTIC APOTHECARY CAMDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH (KEVIN)
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-653-9355
Mailing Address - Street 1:103 S DUPONT BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1549
Mailing Address - Country:US
Mailing Address - Phone:302-653-9355
Mailing Address - Fax:302-653-9388
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934
Practice Address - Country:US
Practice Address - Phone:302-697-9355
Practice Address - Fax:302-387-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA3-00010243336C0003X
DEA3-00009633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141519OtherPK