Provider Demographics
NPI:1992892186
Name:APOTHECARY PHARMACY INC
Entity type:Organization
Organization Name:APOTHECARY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-994-0690
Mailing Address - Street 1:1500 SOUTHGATE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2259
Mailing Address - Country:US
Mailing Address - Phone:650-994-0690
Mailing Address - Fax:650-994-1538
Practice Address - Street 1:1500 SOUTHGATE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2259
Practice Address - Country:US
Practice Address - Phone:650-994-0690
Practice Address - Fax:650-994-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY493033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA467670Medicaid
0586012OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0586012OtherNCPDP PROVIDER IDENTIFICATION NUMBER