Provider Demographics
NPI:1053491951
Name:THE APOTHECARY SHOPPE PHARMACIES, LLC
Entity type:Organization
Organization Name:THE APOTHECARY SHOPPE PHARMACIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR OF OPERATIO
Authorized Official - Phone:989-837-3636
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:
Practice Address - Street 1:4011 ORCHARD DR
Practice Address - Street 2:SUITE 1004
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-0001
Practice Address - Country:US
Practice Address - Phone:989-839-3636
Practice Address - Fax:989-839-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010071343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI874163917Medicaid
MI2324274OtherNCPDP
MI504163908Medicaid
MI540E611080OtherBCBS DME
MI504163908Medicaid