Provider Demographics
NPI:1386078830
Name:APOTHECO PHARMACY LINCOLN PARK LLC
Entity type:Organization
Organization Name:APOTHECO PHARMACY LINCOLN PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-869-2820
Mailing Address - Street 1:788 MORRIS TURNPIKE
Mailing Address - Street 2:FL 3
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:973-869-2820
Mailing Address - Fax:973-869-2822
Practice Address - Street 1:2140 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4385
Practice Address - Country:US
Practice Address - Phone:312-392-5801
Practice Address - Fax:815-784-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-01
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540182523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL462488983001Medicaid
ILF300159987Medicare PIN