Provider Demographics
NPI:1104868983
Name:APOTHECARE PHARMACY LLC
Entity type:Organization
Organization Name:APOTHECARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-588-6800
Mailing Address - Street 1:623 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3307
Mailing Address - Country:US
Mailing Address - Phone:508-588-6800
Mailing Address - Fax:508-588-6866
Practice Address - Street 1:629 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3307
Practice Address - Country:US
Practice Address - Phone:508-588-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS898203336L0003X
3336C0003X, 3336C0004X, 3336L0003X, 332BP3500X
MA3451332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136215OtherPK
MA110073017AMedicaid
2238889OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MA6696830001Medicare NSC
MA2238889OtherNCPDP
DS89820OtherSTATE LICENSE