Provider Demographics
NPI:1194805234
Name:THE APOTHECARY SHOPPE PHARMACIES, LLC
Entity type:Organization
Organization Name:THE APOTHECARY SHOPPE PHARMACIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:800-313-3677
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48641-1727
Mailing Address - Country:US
Mailing Address - Phone:800-313-3677
Mailing Address - Fax:866-582-3636
Practice Address - Street 1:244 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5114
Practice Address - Country:US
Practice Address - Phone:989-835-3636
Practice Address - Fax:989-832-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010074403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E610610OtherBSBC DME
MI2363050OtherNCPDP
MI502363050Medicaid
MI874717710Medicaid
MI540E610610OtherBSBC DME