1588673743 NPI number — APOTHECARY PHARMACY, INC

Table of content: (NPI 1588673743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588673743 NPI number — APOTHECARY PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOTHECARY PHARMACY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HALF MOON BAY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588673743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 STONE PINE RD STE I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALF MOON BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94019-8202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-726-5542
Provider Business Mailing Address Fax Number:
650-726-0513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 STONE PINE RD STE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALF MOON BAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94019-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-726-5542
Provider Business Practice Location Address Fax Number:
650-726-0513
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAI
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
650-726-5542

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY 54653 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHY 54653 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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