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NPI Code Detail

MEDICARE: APOLLO PHARMACY GROUP, INC.

MEDICARE: APOLLO PHARMACY GROUP, INC.
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
13336C0003XCommunity/Retail Pharmacy517OR
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13811557OTHERORNCPDP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184779548
Entity Type Code : Organization
Provider Name (Legal Business Name) : APOLLO PHARMACY GROUP, INC.
Provider Business Mailing Address
First Line : 113 E CENTRAL AVE.
Second Line :
City : SUTHERLIN
State : OR
Zip : 97479-9556
Country : US
Telephone Number : 541-459-2712
Fax Number : 541-459-9129
Provider Business Practice Location Address
First Line : 113 E CENTRAL AVE.
Second Line :
City : SUTHERLIN
State : OR
Zip : 97479-9556
Country : US
Telephone Number : 541-459-2712
Fax Number : 541-459-9129
Authorized Official
Title or Position : PHARMACIST-IN-CHARGE
Name : ALLEN REECE
Credential : PHARMD
Telephone Number : 682-556-6053
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/25/2023

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