Provider Demographics
NPI:1487793121
Name:THE APOTHECARY SHOP WHOLESALE INC
Entity type:Organization
Organization Name:THE APOTHECARY SHOP WHOLESALE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MUSIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:623-434-3650
Mailing Address - Street 1:23620 N 20TH DR
Mailing Address - Street 2:STE 12
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0621
Mailing Address - Country:US
Mailing Address - Phone:623-434-3650
Mailing Address - Fax:623-434-3676
Practice Address - Street 1:23620 N 20TH DR
Practice Address - Street 2:STE 12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0621
Practice Address - Country:US
Practice Address - Phone:623-434-3678
Practice Address - Fax:623-434-3651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APOTHECARY HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZW001701333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy