Provider Demographics
NPI:1154624856
Name:APOTHECARY PHARMACY LLC
Entity type:Organization
Organization Name:APOTHECARY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAME
Authorized Official - Suffix:
Authorized Official - Credentials:PHCY TCH
Authorized Official - Phone:727-329-8868
Mailing Address - Street 1:4749 34TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4507
Mailing Address - Country:US
Mailing Address - Phone:727-329-8868
Mailing Address - Fax:727-329-8662
Practice Address - Street 1:4749 34TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4507
Practice Address - Country:US
Practice Address - Phone:727-329-8868
Practice Address - Fax:727-329-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-19
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH251393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003180800Medicaid
2128161OtherPK
FL003180800Medicaid