Provider Demographics
NPI:1982700589
Name:APOTHECARY CONVENIENCE PHARMACY, INC.
Entity Type:Organization
Organization Name:APOTHECARY CONVENIENCE PHARMACY, INC.
Other - Org Name:APOTHECARY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BUSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:406-454-2399
Mailing Address - Street 1:20 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3188
Mailing Address - Country:US
Mailing Address - Phone:406-454-2399
Mailing Address - Fax:406-454-3651
Practice Address - Street 1:20 3RD ST N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3188
Practice Address - Country:US
Practice Address - Phone:406-454-2399
Practice Address - Fax:406-454-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2705652OtherNCPDP ID #
MT210353Medicaid
MT0560391Medicaid
MT0560391Medicaid