Provider Demographics
NPI:1487747655
Name:APOTHECARE OF PLYMOUTH INC
Entity type:Organization
Organization Name:APOTHECARE OF PLYMOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-732-9700
Mailing Address - Street 1:121 CAMELOT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3037
Mailing Address - Country:US
Mailing Address - Phone:508-732-9700
Mailing Address - Fax:508-732-9788
Practice Address - Street 1:121 CAMELOT DR STE 3
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3037
Practice Address - Country:US
Practice Address - Phone:508-732-9700
Practice Address - Fax:508-732-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3481332B00000X, 3336C0004X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3481OtherSTATE LICENSE
2241595OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA11074421AMedicaid
MA5769550001Medicare NSC