MEDICARE: APOTHE SPACE DRUGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	027711	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3351448	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1013940576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOTHE SPACE DRUGS LLC

Provider Business Mailing Address
First Line	:	13618 39TH AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13618 39TH AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5516
Country	:	US
Telephone Number	:	718-321-7421
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ERIC TENG
Credential	:
Telephone Number	:	718-321-7421

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

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