Provider Demographics
NPI:1982882429
Name:APOTHECARY BOTANICA
Entity Type:Organization
Organization Name:APOTHECARY BOTANICA
Other - Org Name:EL MACERO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BRAZILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:530-231-6520
Mailing Address - Street 1:417 MACE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6053
Mailing Address - Country:US
Mailing Address - Phone:530-231-6520
Mailing Address - Fax:530-231-6429
Practice Address - Street 1:417 MACE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6053
Practice Address - Country:US
Practice Address - Phone:530-231-6520
Practice Address - Fax:530-231-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy